Tuesday 12 April 2016
[Graham Stringer in the Chair]
Dementia and Alzheimer’s Disease
Order. Before I call Jim Shannon to move the motion, I must explain that we are having technical difficulties. The debate is hugely over-subscribed—many people want to speak—so it is likely that after Jim Shannon has spoken I will impose a time limit. However, there is no connection between my clock and the clock on the wall, which is going to be a difficulty for speakers. When Jim Shannon has spoken, I will explain what we are going to do.
I beg to move,
That this House has considered dementia and Alzheimer’s disease.
I thank all Members who have very energetically turned out in large numbers to support this debate. I am going to keep my speech to 15 minutes to give everybody else a chance to participate. I thank the shadow Minister for being here, and it is good to see the Minister in her place. We always get a good response from her, so I look forward to that.
Yesterday, we had a digital debate in preparation for this debate, and I have got some stats to give hon. Members an idea of how it went. It was organised by Lucinda Blaser and the staff of my office. We reached almost 3 million Twitter accounts, and a total of 1,100 tweets were sent throughout the day. There was an enormous amount of interest outside this House in yesterday’s debate, and the same is true of today’s debate.
I want to speak about the issues that concern me. It is hard to find someone whose life has not been touched in some way by Alzheimer’s or dementia. People up and down the country—unfortunately including many in my constituency—are affected by those indiscriminate diseases. Alzheimer’s and dementia know no class, colour, creed or gender; they can affect any of us. It is extremely important that we have this opportunity in Westminster to discuss advances in ways of tackling the disease. This debate raises awareness and puts the issue of dementia and Alzheimer’s on the agenda for the whole of the United Kingdom. All Members will bring their own knowledge of this subject to the House. We will hear contributions from Members from across the whole of the United Kingdom of Great Britain and Northern Ireland.
According to the Alzheimer’s Society, our ageing population will increase the trends. In 2015, 720,000 of the 856,000 people known to have dementia were in England, 45,000 were in Wales, 70,000 were in Scotland and 21,000 were in my home nation of Northern Ireland. In my trust area, which includes Lisburn, North Down, Down and Ards, the level of dementia is 25% higher than that of England after age standardisations. We have a higher level of dementia and Alzheimer’s in my constituency than anywhere else in Northern Ireland.
I congratulate the hon. Gentleman on securing this absolutely vital debate. This is not just about the total number of cases of dementia that are now being registered; it is about the increase down the line. In my constituency, we are looking at an estimated increase of 30% over the next five years in reported dementia cases. Will the hon. Gentleman reflect on the increasing incidence of dementia?
The hon. Gentleman is absolutely on the button on this issue. Very quickly on the figures, because stats can sometimes overawe us, it is estimated that by 2025 1.1 million people will have dementia and Alzheimer’s, and by 2051 2.1 million people will have the diseases. The numbers are enormous.
I congratulate the hon. Gentleman on securing this debate on such an important topic. On the increase in numbers, does he agree that some vital work is being done on mitigating the symptoms of Alzheimer’s, not least in many care homes and residential homes in my constituency? Equally, we have to focus on palliative care for people with Alzheimer’s at the end of their life.
I was going to come to that issue. I thank the hon. Gentleman for that intervention. It is not just about the diagnosis of dementia and Alzheimer’s, but about the follow-up, the path of care and how we help the whole way through. I will touch on some of those things later in my speech.
We must not abandon or diminish our efforts to find a cure. We have to take into account the reality we face and carefully plan for the future, so that all those with dementia and Alzheimer’s can get the care and support they so desperately need. As the hon. Gentleman said, that is the issue we have to address.
We are talking about end-of-life support, but we have to take a practical approach. One of the charities in my constituency—Community Concern Erewash—has a project to dementia-proof houses in Erewash to help people in the early stages of dementia stay in their houses for longer. They are doing things such as labelling drawers and rooms, so that people know exactly know where they are and can navigate their house for longer. Does the hon. Gentleman agree that such practical measures will make a difference?
The hon. Lady is absolutely right. The simplest things can make a difference. It is about improving quality of life and letting people with dementia and Alzheimer’s have a life with their families.
I congratulate the hon. Gentleman on securing this debate. He makes a very important point, which is that we are concerned not only about those with the condition, but about their carers, of whom there are now 750,000. Does the hon. Gentleman agree—I have been talking to my local Alzheimer’s Society about this—that we have to ensure that we have information and provide access to support and networks so that carers do not feel isolated, as they often do?
I thank the hon. Gentleman for that contribution. In the digital debate yesterday, there was mention of the clusters for those caring for people with dementia. There are 82 across the UK mainland, including some in our area and in Scotland and Wales. Lots of things are happening, and we need to see them develop.
To be fair—I know the Minister will say this in her response—the Prime Minister made very good comments about the 2020 challenge on dementia, which contains some marvellous things that can pave the way forward. The simple things can really make a difference and change people’s lives easily.
I applaud the hon. Gentleman for securing this very important debate. He is talking about getting the simple things right. In the Medway towns, we have dementia cafés—one is located in Medway—where families and sufferers can be brought together to share their experiences and get the support they need in their local area, which is absolutely vital at that time.
I thank the hon. Gentleman for that point.
This is such an important debate, and it is really important that we air all of these issues. It is about the simple things in many cases, but it spreads across a wide network. One of the respite centre residents of Dementia Care—an excellent charity in my constituency—was recently admitted to hospital for a routine procedure but was not released from hospital until 3 am, which threw their entire programme for the next day. More carers were needed to get them back into a routine. Simple things make a huge difference to such people and those who care for them.
The hon. Lady speaks with knowledge. I thank her for that contribution.
There are ten key indicators of the quality of life of people with dementia: communication difficulties; relationships; environment and surroundings; physical health; a sense of humour; independence; a sense of personal identity; the ability to engage in activities and the opportunity to do so; difficulties with eating, drinking and swallowing; and, of course, their experience of stigma. All of those things are important.
I congratulate the hon. Gentleman on securing this debate. As he draws these strands together, there is one problem that we should focus on. Local authorities have many statutory responsibilities, but as a result of the significant cuts to their budgets, these areas—they are not statutory responsibilities but, as a number of colleagues identified, they play a huge role in enabling people to manage their condition, stay active for longer and provide respite for their carers—are being cut back, which will ultimately have a long-term cost for the health service.
Obviously, the right hon. Gentleman has a focus on the issue. We will throw that ball in the Minister’s direction and perhaps she will answer that as well.
Dignity and quality of life are far too easily taken for granted, but simple things are so often lost when someone is diagnosed with Alzheimer’s or dementia. To do what we can to facilitate a better quality of life for those who through no fault of their own are so diagnosed is what I hope we came to this House to do—to make a difference. Yesterday, it was deeply encouraging to see from the digital debate how many bodies are active in the field of dementia and Alzheimer’s.
There are many issues to consider as part of dementia awareness, although one that is often overlooked is sight. I met an optician from Newtownards last week, and what I learned prompted me to mention the subject now. All too often, it is assumed that someone with dementia will gain no benefit from a sight test and vision correction, simply because they have a cognitive impairment or might not work, drive or read. Good eye health and good vision, however, can play an important role in supporting the wellbeing of a person living with dementia. Again, I ask the Minister for a better strategy. I know that opticians’ organisations would be happy to assist. Good vision can greatly increase a person with dementia’s sense of independence, allowing them to continue to participate in daily tasks and activities and in obtaining a good quality of life.
Does the hon. Gentleman intend to cover why there is an increase in dementia? Many of us are dementia friends, but why is there an increase in this awful illness? Do we know?
I would need to the wisdom of Solomon to answer that question. Personally, I do not know; perhaps it is society or how we live. People are living longer and, by the very nature of living longer, we have such problems. There are probably a number of issues involved and reasons for that. However, early diagnosis, follow-on care and end-of-life care are fundamental.
There is a need to raise awareness among people with dementia and their carers about the disruptions to vision and eye health that might be concurrent with or arise from dementia. We therefore need to emphasise the importance of regular sight tests and eye examinations.
The Mental Health Charter for Sport and Recreation has done some interesting and outside-the-box things for people living with dementia. Along with partners, they have delivered a dementia-friendly swimming initiative, which is steadily expanding across the country. That is an absolutely fantastic way to help improve quality of life. It is amazing how not-for-profits are putting in the hard graft to make heart-warming things such as that happen, often with no funding. It is amazing what a group of dedicated, selfless individuals can do, as has been mentioned.
I thank the hon. Gentleman for giving way and I apologise for missing his opening remarks. Will he take the opportunity to commend the many local communities that have sought dementia-friendly status, meaning that a visit to the shop is not too embarrassing or a stigmatising event for sufferers or their carers?
The hon. Gentleman has clearly hit on a very salient point.
In relation to the science and medical sectors, I ask the Minister about the significant spend on and moneys set aside for the investigation into how dementia happens, which the hon. Member for Beckenham (Bob Stewart) asked about in his intervention. That money will help to find a cure—and we need to find a cure, because we have to give hope. To give hope, we have to have medical interventions and the investigations leading to them.
The hon. Gentleman is talking about a cure. Recently, I visited the department of human genetics at the University of Nottingham, which is working hard on a genomics project to identify the change in the genes that might cause dementia and Alzheimer’s, so there is light at the end of the tunnel, although it is a long way off. Great work is being carried out, however, not only in Nottingham, but in many places in the UK and throughout the world.
We have to encourage all medical advances.
The number of people living with the condition in the UK is revealed as more startling when we take into account the unsung heroes—the carers.
I congratulate the hon. Gentleman on obtaining this debate. He made an important point about the unsung heroes, the carers. Does he agree that often the people who provide the care in the home rely on outside visits, but those are short-term visits, which are not really the answer to support the carer or the person suffering from Alzheimer’s disease or dementia? More work on policy development and resources needs to be invested in by Government in the vital area of caring.
I thank the hon. Lady for a valuable intervention.
Carers UK estimates that, of the 6.5 million carers in the UK, 670,000 people care for friends or relatives with dementia. It is estimated that the NHS saves some £11.6 billion each year because of those unsung heroes; their contribution as volunteer carers is very valuable. Carers may end up providing more than 100 hours of care per week, and all too often the outside world is completely oblivious to their efforts—even those who know the carers might be oblivious, because they do not know what is happening. Anyone who has lived with someone with dementia or Alzheimer’s, or knows a person who does, knows the problems. People with dementia can often unknowingly become agitated, even violent, and night-time wandering and shouting can have a serious impact on carers’ sleep patterns, let alone sufferers’.
I congratulate the hon. Gentleman on securing this debate. Talking about awareness and carers, does he agree with me that a large number of carers might not even be aware of, but need to be taught, how to help and look after? We need an awareness campaign.
We do need an awareness campaign—perhaps it starts with this debate today, working its way through to our constituencies and the people we represent.
Too often, carers are left to suffer in silence. The existing services on offer are not publicised enough and are not up to standard. The main social security benefit available to carers is the carer’s allowance. Those providing more than 35 hours of care a week are entitled to only £62.10. Further to that, carers may incur sanctions on how much they can earn on top of the allowance. Dementia carers save the NHS more than £11 billion every year, but they get only £62.10 per week for giving up their lives for someone less fortunate. I know the Minister’s Department is not responsible for that but, with respect, it is not a good reflection on Government given the hours spent by carers. Times are tough for the public finances, but it must be highly insulting to carers for them to see some of the things happening in the news when they are getting only £62.10 a week.
Familiarity has been mentioned, and that is an important role for carers to play. My own grandmother deteriorated every time she was in hospital, because of the lack of familiarity. Does my hon. Friend support John’s Campaign, which encourages the provision of more time and greater support for carers in the hospital setting, as well as greater flexibility about the hours they can be there with their loved ones?
My hon. Friend makes a salient point. He always hits on the issues that we should all be aware of.
I welcome the fact that the Government are developing a new carers strategy. I can only hope that this debate will raise awareness of the need for urgent and large-scale reform of the way in which the Government treat carers. I welcome the dementia-friendly communities strategy and the clusters of dementia groups. In my constituency we have a number of homes where patients with dementia and Alzheimer’s are looked after directly. I also have a dementia friends group who come together in the Church of Ireland church in Newtownards. They bring together all the people of Ards and North Down who want to participate. They give them art, they give them music and they give them a chance to interact, and it is marvellous what happens.
Briefly, I want to mention some of the things that happen in Northern Ireland. The Northern Ireland dementia strategy has a list of achievements to its credit in recent times, which I bring before the House to help the debate: £6.25 million in the Dementia Together Northern Ireland project; the appointment of dementia champions—perhaps the Minister will give us some thoughts about dementia champions in the whole of the United Kingdom, because things are happening, but I would like to hear about them.
On dementia champions and dementia friends, will the hon. Gentleman join me in praising the wonderful work that is done by them, especially in providing sufferers with familiarity—the point made by the hon. Member for Belfast East (Gavin Robinson)? One of the ideas is to provide sufferers with things such as memory boxes to trigger the memory, which helps terrifically with this dreadful disease.
I thank the hon. Gentleman for his intervention.
I commend the hon. Gentleman for securing the debate. On Northern Ireland, he may be aware that the Joseph Rowntree Foundation supports the Dementia without Walls programme, and one place in which it has done something is in a city with walls—the Derry Engaging and Empowering Dementia project has included: work at the level of schools and everywhere to ensure that everyone is more aware of dementia; and Derry having the first dementia-friendly pantomime in Ireland last December, in the Millennium Forum.
I thank the hon. Gentleman for his intervention and for giving an example of some of the good things happening throughout the whole country.
I tabled an early-day motion some time ago to highlight what can happen in people’s homes, and I suggested issues such as smoking, drinking, diet, excessive weight, healthy weight and social interaction, which is so important. Many may enjoy a tipple or an alcoholic beverage, but for too long alcohol has been overlooked as a cause of dementia. The hon. Member for Beckenham asked what some of the causes are, and that is one of them. No one is saying to people to go cold turkey or to hang up their dancing shoes, but the facts are there and they need to be heard.
We have alcohol-related dementia, which is formally attributed to alcoholism, and conclusive evidence now shows that heavy drinking over a long period increases the chance not only of dementia in the long term but of early onset dementia. To illustrate that, Alcohol Concern has provided comparative data showing that the brains of men who drank more than four units of alcohol a day—approximately two or three drinks a day—over 10 years age at a higher rate than those of light or non-alcohol drinkers. The brains of men who regularly drank alcohol appeared between 1.5 and 5.7 years older than their healthier counterparts. Those are just some of the things we have got to address.
One other thing we have done in Northern Ireland is provide funding for dementia-specific nurses, new studies into treating dementia—seven studies are taking place in Northern Ireland—and we have clinical leads for research. That is what we need to do. I thank the Minister, the shadow Minister and right hon. and hon. Members for coming to participate in the debate. I hope that my comments and the interventions have helped to focus attention and that we can do a lot more in advancing the race against dementia and Alzheimer’s, supporting the carers better and furthering awareness of the potential causes.
Order. Given the technical difficulties, the number of people who wish to speak and the fact that I intend to call the Front-Bench spokespeople at around 10.30 am, if my arithmetic is right, we are due to go over that time. I will put on a time limit of four minutes and not add time for interventions, because that gets too technically complicated. I hope that is clear. That will probably take us just over 10.30 am. The Clerk tells me that, to aid right hon. and hon. Members, a bell will be rung one minute before the end of their speech time limit.
I cannot wait to hear the bell! I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. We know that there are more than 800,000 people with dementia in the UK today and that by 2040 that number is expected to double. I did a bit more digging into my constituency and found that Aldridge-Brownhills is ranked 220th by age standard prevalence.
My constituents are concerned about this subject—they have written to me about it—and probably most of us in the Chamber have been affected through knowing someone who has or who has had it. We often wrongly associate it with age, but the reality is that more than 40,000 younger people—people under 65—currently live with the condition, so I hope that one result of this debate will be a recognition that it does not just come with age.
Research also shows that dementia costs the UK a staggering £23 billion a year, which is more than the cost of cancer, heart disease or stroke. It is equally concerning that the diagnosis rate has been historically low. That is why I welcome the Government’s objective and the work they are doing to be a world leader in fighting dementia and their commitment to improve diagnosis, care support and research. That must be welcomed. However, it is worth recognising that as vital research goes on, the condition does not go away. We must recognise dementia’s impact on families. It can be very difficult to look after someone who has dementia and, especially in the early stages before they are diagnosed, trying to understand what the problem is and how to help them.
As has been touched on, we also need to recognise that it can be difficult and distressing for those with dementia when they go into hospital. To be in a different environment, away from familiar surroundings, is hard at the best of times, but it is even more so for those with dementia. Time in hospital can have a negative effect on the health and wellbeing of people with dementia and, as has been highlighted, delays in discharge can also exacerbate problems.
We have talked about the role of carers—not just the paid carers, but the unpaid carers who are there 24/7, looking after their loved ones. They do not get any respite and they often have a hard time of it. [Interruption.] Thanks for the bell. A couple of years ago, I had the opportunity to do the “dementia friends” training session with the Alzheimer’s Society and to help to organise some training sessions. The one thing I took from those sessions is that all of us—even those who are not carers or do not know much about nursing and the care profession—can do some small, practical things that can make a big difference to people with dementia. In my constituency, we have a dementia-friendly café, and I am looking to set up a dementia friends session, so that we can pass on the word and encourage more people to get involved. I hope that others will do the same.
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on his excellent speech and on securing the debate.
In the north-east, there are an estimated 25,841 people living with dementia. In coastal constituencies such as mine, South Shields, the figures are higher than average due to large elderly populations. Over the coming years the figure is projected to rise locally and nationally, with more than a million people forecast to be living with dementia in the UK by 2021. I am sure the absence of any mention of the NHS or social care in the recent Budget was of little comfort to those who have loved ones living with dementia.
As the numbers of people in need of care and support rise, real action from the Government is lacking. Yes, we have the Prime Minister’s commitment to making England
“the best country in the World for dementia care,”
and we are told that research investment has doubled and policies for improving diagnosis rates are in place, and that there are a million dementia friends, but commitment, research and reliance on charities are no substitutes for the care and support that thousands of people with dementia need right now.
Anyone who has ever had to make the heart-wrenching, emotional decision to have a member of their family placed in a residential or care home, even for a short while, will know that good care, dignity and respect are the cornerstones of providing loved ones with the safety and security they once enjoyed in their own homes. I know about that from my own gran, who was one of the strongest and bravest people I ever knew. As she got older, this strong woman became physically frail and, worse still, her mental health deteriorated too. Gran had dementia and, after many stays in hospital and some painful discussions, our family decided that she needed to be admitted into a care home. She escaped from the first home and was found alone, shivering in a field. At the second home she seemed happy enough, but she suffered an injury through carelessness of staff. If my gran had had carers at home, she would probably have had only one or two visits a day, with all of her getting up, getting dressed, meal times and bed times dictated by the times her care company could come, not when was best for her.
The thing is, though, gran’s story is not unusual; because in an age of increased need and reducing budgets, respect, dignity and choice are always the first to go. They cost nothing on the balance sheet in the first place, yet they mean so much to the people receiving care. This view is supported by the Alzheimer’s Society, which has reported that more than half of carers felt that their loves ones were not treated with understanding and dignity in hospital.
At present, we have a crisis in adult social care and in the NHS. Local authorities predict a £4.3 billion gap in adult social care by 2020, and NHS England and the Nuffield Trust estimate that by 2021 the NHS funding gap could have grown to £30 billion a year. Residential and care home providers and organizations that provide home care say openly that they do not know how much longer they will manage, because they have realized what we all know: there is no real profit to be made in good quality care.
The average cost of a year’s dementia care is £32,250 per person. I have always known that if we are really going to care for people living with dementia and support their families, we need to formulate policy starting with them and their needs. That is the approach that I took when I was a local councillor, and I am proud today that building has actually begun on South Shields’s £9 million centre of excellence for older people, an integrated care services hub with a focus on dementia, which I worked tirelessly on before coming to this place. I know that I do not have all the answers, but I know that the Government need to be more inventive and creative, and to address the crisis right now.
I realise that Members often curl their lip when Conservative Members stand up to tell the Prime Minister how brilliant he is; but since he put dementia on the global agenda in 2012 the horizon has changed remarkably. Between 2012 and 2015 something like £60 million was pumped into research, and there are incredibly ambitious targets for the doubling by 2020 of dementia and Alzheimer’s research. That includes all sources—Government, private and charity.
The issue is all about capacity building; £300 million is now being pumped in, of which £150 million is earmarked for a dementia research institute and an international discovery fund of 130 million quid. However, we must face the fact that the field of dementia research is still very small in comparison with others, particularly bearing in mind the fact that the £26 billion annual cost is more than the combined cost to the country of cancer and heart disease. Despite that, only three new drugs have been discovered in the past 15 years.
Something has to change, and that is why the Government’s announcement of a dementia research institute is so important. It is important for three reasons, the first of which is security for researchers. I do not know how many hon. Members know any scientific researchers, but they are as interested as anyone else in having a career. When they pick a specialism to devote their lives to, they need to know that there is a future in it, and the likelihood of funding to sustain them throughout their career. At the moment, dementia does not provide that. A dementia research institute will do it. At the moment about 70% of PhD graduates in dementia research leave academic research within four years of starting. That is not good enough if we are to find a cure.
Secondly, in the search for a cure, a single molecular target is highly unlikely. There is not a silver bullet to cure dementia. There are many different types of dementia and different underlying influences. If we are to find therapies and cures, and things that will assuage dementia and allow people to live with it, we will need a huge amount of collaboration. In the past 20 or 30 years, the private sector has spent about £30 billion researching dementia across the piece, but that has been happening in different silos, often with researchers working on the same dead ends, and wasting the money three or four times. It is critical that we should collaborate, particularly internationally, in the search for a cure.
Finally, given that there will be no single molecular target, it is unlikely that there will be significant advances on a cure in the next 10 or 15 years. One of the Cinderella research areas, which does not get much funding or concentration, is care, therapy and management. One of my key wishes with respect to the new dementia research institute is that it should become a soup-to-nuts research institute, looking at diagnosis, care, therapy, psychology and support for families, as well as a cure. The Government announced about 18 months ago that the institute would be up and running within five years. That means there are only three and a half years left, and I would be pleased if the Minister updated us on progress, with respect to announcing a location, funding, and who will host the institute. Only once we have that centre of global excellence will we be in a proper position to tackle what is likely to be one of the top five public health challenges of the next century.
I congratulate my ever-industrious friend who secured this important debate, the hon. Member for Strangford (Jim Shannon).
Regardless of where any of us live in these islands, I am sure we agree that, from the point of diagnosis until the end of life, every person living with dementia deserves nothing less than the best care society can provide. In Scotland approximately 90,000 people are living with dementia, about 2,000 of whom live in my constituency. There is barely a family who have not been affected by that awful disease. Indeed, there is probably not a person in the Chamber who has not been affected by the illness. Yet all too often those who suffer from dementia are stigmatised and discriminated against, because their symptoms are sometimes difficult to handle, so they are sometimes treated with less respect and dignity than other members of society. That is unacceptable and must change.
I am delighted that the Scottish Government have made tackling dementia a national priority and that since 2008 they have funded the Scottish dementia clinical research network, which has brought together academics, clinicians, carers and people living with dementia, with the aim of turning scientific discoveries into safe and effective treatments. That collaborative approach is to be commended. Since coming to power, the SNP Government in Holyrood have put those living with dementia, and those who care for them, at the heart of their policy making. In 2011 they published the standards of care for dementia in Scotland, which gave people suffering from dementia guaranteed rights—the right to a diagnosis; the right to access to a range of treatments, care and support; the right to be regarded as a unique individual and treated with dignity and respect; the right to be as independent as possible and to be included in the community; the right to have carers who are well supported and educated about dementia; and the right to end-of-life care that respects the wishes of the person concerned.
I applaud the Scottish Government for the great work they are doing, but it is important to recognise that it would not all be possible without an army of people committed to caring, and to making and implementing policies. Scotland is blessed with a volunteer corps and carers who make that possible. In Argyll and Bute 2,000 people are living with dementia. A couple of months ago I was privileged to be invited to open, in my home town of Helensburgh, the brand new Alzheimer Scotland dementia resource centre, which has taken dementia care—figuratively and literally—from the back and side streets on to our high street. Our community now has a central hub, where people trained to provide support and education are constantly available. There is a drop-in centre, a performance area and a café, as well as space for individual and group therapy. It is a wonderful resource and I congratulate Alzheimer Scotland and its staff on achieving so much and making that happen—particularly Susan Russell, the service manager, and Jean Armitage, the policy and engagement manager. We know that dementia is a growing problem and that we have to tackle it; but let us not forget that there are already wonderful people making things happen in the community.
I pay tribute to the hon. Member for Strangford (Jim Shannon) for securing this important debate and for his long-standing focus on the issue. Last September when I was able to secure a debate on this subject I was very grateful to him for attending, and for his eloquent words, and I want to reciprocate today.
The subject is one of great significance—a significance that grows every day as our population ages and our life expectancy grows. It is an issue that is personally hugely important to me. I have supported the Alzheimer’s Society for many years, and recently in the House I co-hosted with the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) a dementia friends session for Members and staff. I am very grateful for all the work that she does on this issue.
Dementia is incredibly cruel. It can take a person away from us, even while they are still with us. As the hon. Member for Strangford and my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) set out, the basic facts are stark. My hon. Friend in particular drew attention to the challenge of early-onset dementia, which can often be forgotten, and we must remember the specialist services and support that people with early-onset dementia need and cater for them.
This is not a party political point. The Labour party should be very proud of its record in government on this subject, and I believe that this Government and this Prime Minister can rightly be proud of ours. We have heard a lot about the importance of awareness and understanding, care and treatment and research. My hon. Friend the Member for North West Hampshire (Kit Malthouse) was characteristically modest in talking about the Dementia Research Institute. The one thing he omitted to say was that it was his idea, and he should be rightly proud of what he has set in motion.
The aspect of this important issue that I want to focus on is the organisations and individuals who do so much to care for and support those with dementia. Setting aside for a moment the human impact of dementia, the estimated cost of dementia is £23 billion per year, with a large proportion of that effectively met by families and voluntary carers. We must remember the army of 670,000 all too often unsung heroes who help and care for people with dementia, as well as organisations such as Age UK and the Alzheimer’s Society, of which I am a member, and local councils and CCGs.
Last year, I had the pleasure of visiting the Poppies Memory Café in Syston, and later this month I will visit the Thrummy Drummer dementia support group in Thurmaston. Both do vital work in supporting those with dementia in Charnwood and providing respite to carers. Alongside the excellent support services in my constituency that play such a vital role for those with dementia and those who care for them, there is another service that is sadly under threat as we speak today. The CCG recently took the decision to cease funding the service based in the Birstall resource centre in School Lane in my constituency, which Age UK has run for many years. It provides a vital lifeline for 19 people with severe dementia and respite for their families and carers, with a further eight people waiting for referrals. The service is not only much valued but extremely well used in Birstall. The removal of CCG funding will cause the service to close, which will have a devastating impact. A glance at the CCG board papers suggests that the decision is not financial; its budget has actually increased.
It is deeply disappointing that the CCG has taken that decision. While I am grateful to the CCG for the time it has taken to set out its views to me, I remain unconvinced of their logic. The reality is that that service is of huge importance to everyone. I suggest that its closure would be a tragedy for those who use it and that the CCG is taking a short-term view in closing it; costs to the NHS will go up in the long term. I would like to take this opportunity to say that it is time for the CCG to pause, think again, accept that it has got this wrong and reverse the decision.
I had not intended to speak; I thought my name had been withdrawn from the list. None the less, having sat and listened to this debate, I would like to take advantage of the opportunity to do so. I will not take even the four minutes that you suggest, Mr Stringer.
This is an immensely personal issue for many families across the country. I reflect on a couple I know very well. The lady of the household started to forget things. She started to repeatedly cook the same menu for her husband, who got rather tired of shepherd’s pie day after day. Those warning signs led to her being referred to a memory clinic, which did indeed diagnose the early stages of dementia. Where that will lead, the family does not know. I emphasise what a harrowing experience it has been for that family. Support services are available in west Wales, where they live, but there is a concern and fear that as this terrible disease goes on, the terrible decision to which the hon. Member for South Shields (Mrs Lewell-Buck) alluded with her family might have to be made and the lady of that household will have to go into some form of residential care.
I want to highlight some of the challenges we have in rural Wales. There is a spectre of couples having to be parted, sometimes over very large distances, which causes agony for other members of the family who want to give support. Of course, the support that is available—often for too short periods—is invaluable to those families, but the lack of residential care in close proximity to where the families reside is a very real problem.
I reiterate the point I made in an intervention to the hon. Member for Strangford (Jim Shannon); I congratulate him on securing this debate because awareness of this devastating disease is so important. We must praise the wider community, including the community councils and district councils that have sought dementia-friendly status so that the everyday pursuits we all enjoy can still be enjoyed by everybody in society, including those with dementia and Alzheimer’s.
It is a great pleasure to serve under your chairmanship, Mr Stringer. I reiterate my congratulations to the hon. Member for Strangford (Jim Shannon) on securing this crucial debate. The attendance is a great testament to the importance of this issue.
I mentioned in my intervention that we were facing a tidal wave in the United Kingdom, and unfortunately my constituency of Solihull is at the crest of that wave. The latest figures I have, produced by the Birmingham and Solihull dementia strategy forum, show that the estimated number of people with dementia is 13,819 in Birmingham and 2,798 in Solihull. That number is predicted to grow by 31% to 3,800 in Solihull and by 18% to 16,300 within Birmingham. My constituency has an acute problem because it has an older population—clearly an older one than Birmingham. In fact, in the ward of Silhill, from which Solihull gets its name, 40% of people are over 65.
This is a hot topic nationwide and an acute one within Solihull. That is one reason why I decided to become a dementia friend in 2014. Like my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton), I took part in a sponsored session. One of the most telling things I remember from that session in Solihull was the discussion about how memory is like two bookcases full of books. If we shake those bookcases, books from different levels fall out. They are never really interconnected; they simply lose their place, and over time more books are lost.
People’s progress down the road of dementia can be fast or slow. Something that was talked about at that session was the idea of “living well” with dementia, which seemed an odd choice of words at the time. We, as a society, have to ensure that we enable people to live as well as possible with dementia. As part of that, we need tailored care packages. Solihull CCG, for example, is leading the way with its virtual wards and trying to help people through step-down facilities from the local hospital. We had a major campaign in Solihull to save ward 10, a specific step-down facility. That led to the creation of a new facility, Ardenlea, over the road, which looks after individuals who are coming out of hospital at the most vulnerable time, when they already have the mighty battle of dementia on their hands.
We need to stop providing care and services in silos, as my hon. Friend the Member for North West Hampshire (Kit Malthouse) said. We need to stop thinking that this is someone else’s responsibility. Dementia care in our society is everyone’s responsibility—that means Members of Parliament, GPs, nurses, healthcare professionals and wider society. We must consider how shops are designed, how we design support services and how we talk to people and interact with them. We need to get dementia-friendly and get on top of this issue, because it is going to be the issue of the 21st century.
I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate.
I am not sure that there is a scarier disease out there. This is a disease where a person loses their mind, no longer remembers who they are or who their family and close friends are, and lives in a world of isolation where they are constantly trying to make sense of what is happening around them. My dad was diagnosed with Alzheimer’s and dementia in 2006. From then on, we mourned the loss of him, piece by piece. We watched him deteriorate from a once handsome, articulate and thoughtful family man to an apparently empty shell, apart from small glimmers of recognition that are, in some ways, harder to bear.
With an ever-ageing population, this dreadful disease is becoming more prevalent. It puts pressure on families, services and communities. This cruel disease often means families can no longer care for their loved ones at home, leading to one of the most heart-wrenching decisions a family ever has to make. They may be able to remain at home, but that often puts a strain on the carer or carers looking after them, more often than not family members. Support must be put in place to allow carers to continue looking after their loved ones for as long as practically possible. They need respite and time away to recharge their batteries. They need aids and adaptations to make life a little easier. They need support from other carers and to be able to seek solace from those going through the same thing.
So what is the future? It is widely recognised that a number of risk factors affect a person’s chance of developing dementia, including age, genetics, medical history, lifestyle and even environmental factors. As my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) said, the Scottish Government have made dementia a national priority. We believe that a rights-based approach to dementia care, treatment and support is vital and we will build on that with the upcoming third dementia strategy. The strategy for 2016 to 2019 will set out key priorities: to improve support in all areas of dementia care, particularly palliative care and end-of-life care; to prevent avoidable hospitalisation, because unfamiliar surroundings can cause untold distress to dementia suffers and their families; to redesign dementia services; and to capitalise on community assets and grassroots initiatives, such as the excellent South Ayrshire Dementia Association in my constituency and many more like it. As the number of people with dementia in Scotland and the UK grows, it is of the utmost importance to have good care in place. The Scottish Government will continue to reduce the risk factors for dementia by encouraging and enabling healthy and social lifestyles.
None of us knows what is in front of us. I can only hope and pray that a cure is found one day and we can stop our loved ones being slowly taken away from us in such a cruel way.
I am grateful for the opportunity to serve under your chairmanship, Mr Stringer, and to the hon. Member for Strangford (Jim Shannon) for raising this important subject.
Sadly, there is no cure for dementia, but diagnosis is important for understanding and so that support can be provided. Many welcome supportive initiatives have been developed in the community. For example, in my constituency, the local council has taken the lead in helping to make Burnley a dementia-friendly town and even offers free training to licensed taxi drivers. The initiative is part of a town-wide campaign to encourage residents and businesses to become more dementia-aware, helping Burnley to become a dementia-friendly town.
Raising awareness of dementia among transport services is vital. Some people living with dementia may lose the confidence to drive and become reliant on public transport. Taxi drivers may have friendly, familiar faces for people living with dementia and, if they have gone through a dementia information session, may be better equipped to understand their customers’ needs.
Suffering from dementia is difficult, as is caring for someone with it. It is important to recognise the needs of carers and to give them maximum support. I have seen the problems close up. My grandmother suffered dementia caused by Alzheimer’s disease. She moved from experiencing bouts of mild confusion to a total inability to cope unaided. As my family struggled to care for her, there was little if any specialist support or understanding, and eventually the family were forced to make the hard decision to admit her to residential care.
Things have improved since then: awareness has increased and more support is available. Projects such as the Butterfly project, which many hospitals have adopted and which helps to identify sufferers and to train hospital staff, are welcome developments. Sadly, however, carers are still too often undervalued and under-supported.
Last year, when doing research for my private Member’s Bill in which I tried to introduce free hospital car parking for carers, I talked to many carers, including several who were caring for loved ones suffering from dementia. I was affected by many of the stories I heard. One lady told me she had given up her full-time job to care for her husband who had developed dementia. At home, she fed, dressed and comforted him. When he fell and broke his hip and had to be hospitalised, she continued to provide the same care. She visited him every day, staying long hours, helping with his basic care and bringing calm. If she had not been able and willing to take on that role, it would have fallen to NHS staff.
It is estimated that carers save the NHS billions of pounds every year. At the same time, because caring duties may necessitate them leaving paid employment, many carers suffer financial hardship. I am shocked that the Government chose not to support my Bill, which would have offered some small assistance to carers. It would have sent a strong message of support to carers up and down the country that we value them. The way forward must be to increase awareness and to properly resource support for dementia sufferers and their carers.
Mention has been made of the Prime Minister pumping money into research, which is welcome, but while there is no cure, I would like the Prime Minister to pump money into improving care. That is not only the decent thing to do; it makes sound economic sense.
I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate and pay tribute to him for his excellent speech, which will have touched many hon. Members here, as evidenced by the turnout today, and our constituents.
My father’s mother was diagnosed with Alzheimer’s years before I was born and my only memories of her, albeit fond, are of her diminished self. My father has told me about how kind, warm and generous his mum was, but Alzheimer’s changed her personality and made her short-tempered, intolerant and at times aggressive. She was nothing like the big-hearted and loving wife and mother her family knew so well. In her final months, she was unable to recognise my dad, and that was heart breaking for him and the rest of the family. I remember that distinctly.
As a young boy, it was difficult for me to understand why she kept asking if she was a pest and required an answer every time. She seemed remote and at the time I did not know why. On one visit to us in Orkney, when my grandfather was admitted to hospital for an operation, she insisted on going to the shops to buy sweets for my brother and me, but would not hear of anyone taking her. In the end, my parents had to compromise, so I went with her: a four-year-old guiding and making sure a 71-year-old found her way and got home again.
I cannot imagine how difficult it must have been for my grandfather, my dad and my auntie to watch that slow decline in someone who was once central to the whole family—a war-time wife and mother, and a proud, capable and clever woman. The way my grandfather cared for her well into his 70s was phenomenal and incredibly touching. When she was hospitalised, he visited her twice a day, his own health suffering after years of devoted care and worry.
It is difficult not to speak about the negative impact of Alzheimer’s because the results are real and devastating. It is also difficult to see beyond the illness, when for so many loved ones that is what dominates their daily lives for many years, but wonderful work going is going on to help people with different forms of dementia and their families. In my area, NHS Lanarkshire is working with Dementia Friends Scotland and Alzheimer Scotland to run a dementia friends programme at Wishaw general hospital that supports staff to recognise the signs of dementia and supports them in recognising that people with dementia can live fulfilling lives when given the care, support, respect and dignity they deserve.
It is important to put on the record the five key messages of the dementia friends programme: dementia is not a natural part of ageing; it is caused by brain disease; it is not just about losing your memory; it is possible to live well with dementia; and there is more to the person than dementia. It is important that we are all mindful of our language and actions. This debate is helpful in highlighting some of the issues that the dementia friends work so hard to bring to the fore. We all recognise the challenges faced by those with dementia and their families. We cannot hide away from them. They are faced from diagnosis through to end-of-life care.
If I had more time, I would have liked to touch on some of the Scottish Government’s excellent work. I am glad that my hon. Friend the Member for Argyll and Bute (Brendan O'Hara) mentioned it and I thank him. In February, they introduced the Carers (Scotland) Bill, which enshrines in law for the first time in Scotland the rights of carers, coupled with a commitment, if re-elected, to raise the level of carer’s allowance to match that of jobseeker’s allowance.
I am grateful for the opportunity to speak today and I thank the hon. Member for Strangford for raising the matter.
I thank hon. Members for co-operating with the time limit on speeches, but if I am to get the last two speakers in, I must reduce it to three minutes.
Thank you, Mr Stringer, for allowing me the opportunity to speak in this very important debate. It is a pleasure to serve under your chairmanship.
I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. I also congratulate the Bradford District Care NHS Foundation Trust on winning a national gold award for its work in the state-of-the-art dementia assessment unit at Lynfield Mount hospital.
The 850,000 people living with dementia today deserve to be properly supported to live dignified lives, but worryingly an Alzheimer’s Society poll found that 90% of people suffering from dementia felt that the support they received after diagnosis was inadequate, and 73% of GPs—the medical practitioners who arguably are on the front line in managing dementia in our communities—believe that our health and social care system is confusing for people with dementia and, importantly, their carers. As a society, we need to support dementia sufferers soon after diagnosis, so that they are properly prepared to manage their symptoms, especially as the symptoms will worsen as the illness progresses. They are best placed to plan and prepare their affairs, but they must be helped to do that. At present, those suffering from dementia are not properly supported by the Government.
As a society, we should also be supporting the legion of selfless carers across the country, who contribute £11.6 billion to the UK economy each year through that unpaid caring. Often, carers feel unsupported and isolated. We must ask ourselves as a society whether it is fair that those carers, contributing £11.6 billion in unpaid service each year, are allowed to feel unsupported and isolated.
That prompts the question: what more should the Government be doing? We are fortunate that there is no need to reinvent the wheel. An initiative run by the Alzheimer’s Society is already being piloted in communities. The carer information and support programme is aimed at family members and friends after a relative has been diagnosed with dementia. It involves attending information sessions in a group environment. The Prime Minister’s commitment, as shown by the “Prime Minister’s challenge on dementia 2020”, is commendable, and I am happy to place on the record my support, but the target date of 2019-20 is simply not ambitious enough. I therefore call on the Minister to commit in her remarks to exploring what extra funding can be made available now, not in 2019-20, to support the roll-out of the carer information and support programme to communities across our country.
I add my congratulations to the hon. Member for Strangford (Jim Shannon) on his exceptional speech and on securing the debate. It is a pleasure to speak, however briefly, in the debate as a co-chair of the all-party parliamentary group on dementia, as the only MP—I think that is still the case—who is a dementia friends champion, and as a former carer for my mum, who had Alzheimer’s disease. As we have heard today, if anyone’s life has not already been touched by someone who has dementia, it soon will be.
I commend the Government for their commitment and, in particular, the Prime Minister’s challenge and the investment in research funding that was announced last year at the World Health Organisation’s first ministerial conference on global action against dementia. It needs global action; we cannot act in isolation. It is estimated that by 2018 the global cost of dementia will be $1 trillion. I therefore ask the Minister to update us on the longer-term plans for building on that research investment and, specifically, what funding has been set aside to meet the challenges that make up the Prime Minister’s challenge on dementia and whether we are on track.
In addition to research, we need to ensure that hospital services take into account the specific needs of people with dementia. We know from the recent Alzheimer’s Society campaign, “Fix Dementia Care”—my hon. Friend the Member for South Shields (Mrs Lewell-Buck) mentioned some of the results—that 57% of carers, families and friends of people with dementia felt that the person they cared for was not treated with understanding or dignity in hospital; only 2% of hospital staff understood the specific needs of someone with dementia. We obviously need to address that. Could I put in a plug for the APPG report? Seven out of 10 of the people in hospital are not actually there for their dementia, but for something else. We have a report coming out next Wednesday on dementia and comorbidities, and I hope that people will be able to join us for that.
I am sure that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) will mention this in her winding-up speech, but we cannot divorce the issues in relation to social care from dementia care. I called on someone, just in a regular door-knock, and she obviously had dementia. She was on her own. She greeted me with an empty medication bubble pack and just said, “I don’t know what to do.” Too many people are isolated in that way. So many demands are placed on family carers. I hope that the Minister can address some of those issues.
We have gone slightly over time because of the unusual circumstances, so could the Front-Bench spokespeople bear that in mind? You have marginally over seven minutes, and that will leave just over a minute for Jim Shannon.
It is a pleasure to serve under your chairmanship, Mr Stringer. I, too, congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. This subject is close to my heart, as I am sure it is for many people here in Westminster Hall, given the attendance today. I am sure that many hon. Members have a close friend or a family member who has suffered from dementia.
There is no doubt that dementia is a horrible disease that robs sufferers of their personality and their memories—everything that makes them them. The disease also puts severe strain on families and family relationships, as they try to understand and come to terms with it. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) said, it is important to make the point that dementia is not a natural part of ageing.
Some 90,000 people in Scotland are living with dementia, and we have heard today about the different factors that come into play in treating dementia, whether that is research, caring for people with dementia or supporting people who are caring for them. A number of my hon. Friends have mentioned the Scottish Government’s rights-based approach to dementia. Dementia is a disease and it can have a cure. It is great to have heard from many hon. Members about the work going on in their constituencies, whether it is universities or charities that are looking to research a cure.
There has been a lot of talk about carers as the unsung heroes of dementia care. An organisation in my constituency, the Forget Me Not Club, provides more than 500 hours of free care a week. I was amazed at the expertise that the people there had. Heather Morrison and her team do a fantastic job. They told me a couple of stories that I would like to share. They had one client who would continually stamp on the kitchen floor and the family could not work out why the person was doing that. It turned out that the kitchen floor had been designed in tiles of black and white and they thought that the black tiles were raised, so they were trying to stamp them with their feet. That was one part of their dementia. Another sufferer would not wash with soap when they went to the bathroom. It turned out that the soap was the same colour as the sink and bath. They could not see it, which was why they would not wash.
The expertise and experience of the people who work day in, day out with those suffering from dementia is so valuable, and it is so important that we praise the carers. That is why I welcome, as my hon. Friend did, the passing of a carers Bill in the Scottish Parliament earlier this year to enshrine in law for the first time the rights of carers. Furthermore, the Scottish Government’s carers strategy recognises that carers must be seen as equal partners in the delivery of care, as their support enables people to live at home, in their own communities, safely, independently and with dignity. I also welcome the Scottish National party’s pledge to raise carer’s allowance to match jobseeker’s allowance if re-elected.
We have heard that familiarisation is a very important part of tackling dementia and caring for people who have dementia. Not going into hospital and not becoming institutionalised is so important for people with dementia, which is why the Scottish Government identified, in their proposal for the national dementia strategy for 2016 to 2019, a number of challenges to be dealt with, including tackling avoidable hospitalisation, which worsens outcomes for people with dementia every time.
The hon. Member for Strangford mentioned the risks of alcohol as well as other lifestyle factors in contributing to dementia. It is important that we tackle the public health issues around that. I welcome the fact that the Scottish Government are taking steps to encourage people to remain physically and socially active, to discourage isolation and to encourage behaviour that has been recommended by the Caerphilly study.
I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. Does the hon. Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson) agree that the Torbay Dementia Action Alliance’s memory café is exactly the sort of community initiative that can help to provide support to patients suffering from and living with dementia, and to their carers?
I completely agree with the hon. Gentleman. There are a number of strategies and community initiatives. In my constituency, another initiative is live music appreciation. Dementia sufferers and their carers can go along, listen to live music and join in if they want to. That was my first interaction with the Forget Me Not Club in my constituency, and it was a great thing to see.
Finally, the Scottish Government’s national dementia strategy also incorporates Alzheimer Scotland’s five pillars model of post-diagnostic support. Alzheimer Scotland does a fantastic job in providing advice, support and all manner of things for those suffering from dementia and for their carers. Its five pillars model includes:
“Planning for future decision-making…Supporting community connections…Understanding the illness and managing symptoms …Peer support… Planning for future care.”
All the things that charities, local communities, communities and the Government do will help people to live well with dementia.
It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. I recognise the remarkable amount of work that he does on social care and carers, and I thank him for that. We have had some excellent contributions from 14 hon. Members—almost too many to mention, so I will not mention them all. We are making some progress but we have a long way to go to improve care for people with dementia and support for their carers.
The Labour Government launched the first ever national dementia strategy, appointed the first national clinical director for dementia, and commissioned the National Institute for Health and Care Excellence to develop the quality standard for dementia. Together, those began the process of establishing memory clinics, providing better training for GPs and improving the quality of dementia care for people in hospital. I thank the hon. Member for Charnwood (Edward Argar) for mentioning that record. It is welcome that the Government are carrying on that work through the Prime Minister’s important challenge on dementia 2020. I am sure that hon. Members here today agree with the aims of that challenge but we have to accept that there is a long way to go before they become a reality.
Dementia is a distressing condition. In the long term we should be aiming for a cure, but while working to find a cure we must put equal emphasis on the care provided to people with dementia and the support provided to their families and carers. Carers UK reminds us that the symptoms of dementia can make providing care particularly difficult. People with dementia—we have heard about this in the debate—can grow agitated and violent, and night-time wandering and shouting can disrupt carers’ sleep.
Families report challenges in finding services that have the expertise to provide the right care and support. Of course, that means that it is more difficult for carers to get practical help or to take essential respite breaks as they do not have, or they lose confidence in, the quality and appropriateness of the care available. I welcome the strong case made by my hon. Friend the Member for Burnley (Julie Cooper) for better support for carers.
The care sector has a turnover rate of 25% so even when a care package at home is arranged, high staff turnover makes it harder to build familiarity and trust. For people with dementia, receiving care each day from someone they see as a stranger can be upsetting and confusing, and can make them more likely to refuse support, putting further pressure on their family carers. It is clear that improvement is needed, so can the Minister say whether the carers of people with dementia will be a key strand of the upcoming carers strategy?
I applaud the Alzheimer’s Society “Fix Dementia Care” campaign, which wants to ensure that people with dementia receive the highest standards of care in hospital, in care homes and in the home. It is of great concern that a survey of carers of people with dementia found that only 2% believed that hospital staff understood the specific needs of people with dementia, more than half felt that the person they cared for was not treated with understanding and dignity in hospital, and nine out of 10 felt that the person with dementia became more confused while in hospital.
The Alzheimer’s Society is calling for all hospitals to publish an annual statement of dementia care. In my area, it was pleasing that Salford Royal recorded information for patients with dementia and that the records showed that Salford Royal’s performance on a number of elements of care was better than national averages. However, other local hospitals did not record that information so there is much to do to bring that up to standard.
As part of improving hospital care for dementia patients, listening to carers would be a step forward. Nicci Gerrard is leading John’s Campaign for the right for family carers to stay with people with dementia in hospital, as we heard earlier. Nicci’s father John suffered a significant decline when he was in hospital for five weeks. Although the family felt that individual nurses and doctors were kind, conscientious and respectful, restrictions on waiting times meant that the family could not sit and talk to John, read to him, make sure he ate or keep him attached to the world.
John’s Campaign calls for the families and carers of people with dementia to have the same rights as the parents of sick children. They should be allowed to remain with them in hospital for as many hours as they are needed or are able to give. I understand that 272 hospitals across the UK have pledged their support to John’s Campaign. Will the Minister outline what is being done to improve hospital care for dementia patients and whether she supports John’s Campaign?
As well as improving hospital care, there are real concerns about the state of social care. The Association of Directors of Adult Social Services reports that £4.6 billion has been cut from adult social care budgets and that 300,000 fewer people are receiving publicly funded services than in 2009-10. Social care has been an easy target for cuts. I am concerned now that the Chancellor’s aim to find a further £3.5 billion in savings by 2019-20 will hit council and social care budgets even further.
The Government have stated that, by 2020, they want to see an increase in the number of people with dementia being able to live at home with more personalised support available to them and their families. That is a laudable aim, but the Channel 4 “Dispatches” programme last week showed just how poor home care can be, with time clipped from care visits, careworkers working very long days and not being paid for travel time, care needs neglected, and no time for the careworker to talk and listen to the person receiving care.
This year and next year are tough years for social care funding because home care and residential care providers bringing in the so-called national living wage have estimated they will face costs of £330 million in 2016-17 with no additional funding for this Government policy. The better care fund only provides £100 million extra next year, so this year is a problem. It is not surprising that careworkers say that issues with their pay and conditions prevent them from delivering good quality care. Unison found that three quarters of domiciliary careworkers do not have enough time to provide dignified care and that 84% of service users not getting enough time for care are people with dementia.
Caring for someone with dementia is not just about aspects of physical care. It is about conversations—knowing the person and knowing what is a comfort to them. Across hospitals, primary care and home care, we need to improve staff training and understanding of how to support people living with dementia and how to support and work with their family carers.
Carers UK reminds us that carers are the experts in the care needs of the person they care for, so it is heartening that today, Dr Julie Wray of the School of Nursing, Midwifery, Social Work and Social Sciences at the University of Salford is launching her book, “Supporting families and carers: a nursing perspective”. I hope that her nurse colleagues use the book to develop their knowledge of how to work with carers of people with dementia. They are the people who make such a vital contribution to the care of all those people.
I call the Minister. Would you leave a couple of minutes for Jim Shannon to sum up?
I will do my best, Mr Stringer. It is a pleasure to serve under your chairmanship. In the time available, and leaving a couple of minutes at the end, I will not be able to cover all the points raised in this excellent debate. I have never seen the Chamber this full at this time on a Tuesday morning, which is testimony to the importance of this subject.
I start by thanking the hon. Member for Strangford (Jim Shannon), who is a steadfast advocate for this vital cause. There is a great turnout on both sides of the Chamber, and it is clear—explicitly so in some speeches—that dementia and Alzheimer’s are topics that touch many of us in the Chamber today. As others have said, dementia and Alzheimer’s affect 850,000 people in the UK and impact widely on carers, families and wider society. I put on record at the outset my thanks to the wonderful national charities in this field. We value our close working relationship with them, and we value the way that they push us to be the best we can. From what has been said in this debate, it is clear that they have formed important local relationships.
Many hon. Members have made the point that dementia is a global problem that requires international collaboration to find global solutions, and the EU is helping to keep dementia on the international agenda, with the recent Italian and Luxembourg presidencies and the current presidency of the Netherlands prioritising dementia. It is an important issue and a shared agenda. Members on both sides of the House have been generous in supporting the Prime Minister’s 2020 challenge implementation plan, and I echo the support expressed by my hon. Friend the Member for Charnwood (Edward Argar) for the previous work, because we are building on important work done by the previous Labour Government. This is not a partisan issue; it is a challenge to us all. That is true internationally, too. The UK’s international leadership has been strong, and I hope that the UK’s presence will put dementia at the EU’s heart, building on the work that has already been done.
On working with Northern Ireland, as the hon. Member for Strangford knows, healthcare is a devolved matter, with each Administration responsible for its country’s healthcare, but there are many key collaborations and joint initiatives across the UK, notably in research. For example, the Medical Research Council funds dementia research across the UK, including in Northern Ireland, and people in all parts of the UK can sign up to “Join dementia research.” The subject of research has rightly has been much touched on. In particular, the challenges were ably outlined by my hon. Friend the Member for North West Hampshire (Kit Malthouse), who explained why there are particular challenges in this area.
I will reiterate some of the commitments that the Government have made. There will be: up to £150 million for the UK-wide Dementia Research Institute; £300 million to invest in dementia research by 2020; an increase in the total funding for dementia research from the National Institute for Health Research, research councils and charity partners; and more opportunities to participate in research. By 2018, 12% of people newly diagnosed each year will be registered on “Join dementia research,” with 10% participating, but there is more to do. Understanding the causes of dementia will help us to drive the development of treatments and industry innovation. Through things such as the dementia discovery fund, we want to ensure that we have innovative international approaches to making the most of the opportunities that come in the search for a treatment or a disease-modifying therapy, on which we have set ambitious targets.
I also stress, because it has come up again in this debate, the importance of research that also helps us to know best how to support, how to care for and how to improve the lives of people. We are funding things that will have immediate benefits within the next 12 months, as well as things that we hope will bring about a cure or a disease-modifying therapy. One example is that we have commissioned a £20 million research initiative on living well with dementia, funded by the NIHR and the Economic and Social Research Council, which focuses on issues that really matter to people in terms of the practical, day-to-day challenges. Again, there will be opportunities to talk about those in the House.
We have made big progress. Record numbers of people are joining dementia research. We have ambitious targets in that regard, and I hope that hon. Members on both sides of the House can help us to meet them. Diagnosis is vital, as has been mentioned in the debate. Again, huge improvements have been made in the diagnosis rate, from 42% in 2010-11 to 67.4% at the end of February 2016, an increase of around 25 percentage points, but there is more to do, particularly to drive out variation. There is still considerable variation, but ongoing and regular effort is being put into that. I pay tribute to the considerable leadership being given by the NHS’s national clinical director, Alistair Burns.
Meaningful care has rightly been highlighted by Members on both sides as one of the biggest challenges. I am supported by an excellent team of officials in this area, and they are well aware that this is a challenging area. In particular, post-diagnostic support is challenging for the person who is diagnosed, but it is especially challenging for their carers and family. The hon. Member for Bradford South (Judith Cummins) was right to pay tribute to some of her local initiatives and to highlight how big this area is. The joint declaration on post-diagnostic dementia care and support was signed by leaders across the health, social care, local government and voluntary sectors, and it is the first time that we have had an unequivocal joint commitment to improving care and support for people with dementia and their carers following diagnosis. We want to see joined-up plans for health and care support in every area, with personalised care plans for every person with dementia. With NHS England and other partners, we have developed ways to drive that and to measure it within our implementation plan.
Members have rightly said that carers play a pivotal role. I am all too aware of the strain that a dementia diagnosis puts on other family members, which has been rightly highlighted in this debate. We recognise and pay tribute to the pivotal role that carers play. I have touched on progress in research, but I emphasise that we want to see people with dementia, their families and carers live well and have meaningful support.
Time does not allow me to talk in any detail about the carers strategy, but we have launched a call for evidence to inform the cross-Government national carers strategy on what more can be done, and there is clearly much to do in the field of dementia. I encourage all Members to contribute to that, and to encourage their local groups to do so. Carer’s allowance has been touched on. We are rightly being challenged on the money being spent on care, but we are spending more than £2 billion a year on carers’ benefits in Great Britain, supporting more than 750,000 carers. The rate of carer’s allowance has increased since 2010, but I am afraid that time does not permit me to go into detail. I am sure there will be occasions to do so in other debates.
We are further supporting the implementation of improved rights for carers—including carers for those with dementia—enshrined in the Care Act 2014. That is backed by £104 million of funding in 2015-16. The better care fund brings the great promise of more important work on integration, and there are some exciting examples of local initiatives, particularly coming out of Greater Manchester. Again, there will be other opportunities to talk about how the better care fund and those integrated vanguard models can lead the way to more improved care and support for people with dementia.
The role that charities and communities play in enabling people with dementia and their carers to live well through initiatives such as sport, music and dementia cafés has rightly been mentioned. There are some wonderful initiatives, including the Sporting Memories Network, and I pay tribute to all the local initiatives mentioned by hon. Members. I was recently privileged to visit an initiative led by the Manchester Camerata and its music therapist—wonderful work is being done there. There are some 1.5 million dementia friends in England and Northern Ireland doing wonderful work, and a public awareness campaign is under way in Northern Ireland.
There is little I can say in the time available on risk reduction other than that it is vital. Dementia is not an inevitable part of ageing, and up to 20% of those diagnosed with dementia have vascular dementia, the effects of which can be minimised or prevented altogether by a healthy lifestyle. Members are right to draw attention to work on factors such as alcohol, exercise and weight—I hope there will be a chance to say more about that in a future debate. I ask Members to encourage their constituents to take up their free NHS health check. We are piloting initiatives on early-onset dementia awareness.
Let me end by congratulating all hon. Members on their contributions. I refer them to our implementation plan, which was launched last month and has much detail about how we are responding to the Prime Minister’s 2020 challenge. As I close and leave a few seconds for the hon. Member for Strangford to respond, I reiterate that the Government’s commitment to this subject is absolutely undimmed, and it is clear from the contributions this morning that Parliament’s commitment to this important cause also burns brightly.
In the very short time that I have, I thank the Minister, the shadow Minister and hon. and right hon. Members for their significant contributions. All political parties have participated, and all regions have taken part. We all want the same things: advances to find a cure to a global problem; more money to be spent on medical research; thanks to the carers, paid and unpaid; and diagnosis, follow-up care and end-of-life care. Make the simple changes. I thank everyone for their personal stories, too.
Motion lapsed (Standing Order No. 10(6)).
National Defence Medal
I beg to move,
That this House has considered the National Defence Medal.
It is a pleasure to serve under your chairmanship, Mr Stringer. This is a short debate covering a vast subject, and I hope to chart a way forward to a more substantial debate in the near future. I know that a number of hon. Members will want to contribute, and I am keen to allow that, because the topic is worthy of considerable discussion. However, if time runs short, I hope that Members will excuse me if I fail to take as many interventions as they or I would like.
When I began exploring the subject and took on the task of leading this debate, I was concerned about having time to do the research necessary to do justice to the subject, but as it turned out, I need not have worried. Many people have been generous in sharing their knowledge, for which I thank them sincerely, and copying me in on their correspondence with the Government. I appreciate the many people who have taken the time to get in touch with me, both before and since I secured this debate. However, any errors in my speech are mine alone.
In the time allotted, I cannot hope to cover all the anomalies thrown up by the current policy, but there is one that I cannot let pass. Today is the 51st anniversary of the death of Warrant Officer John F. Lonergan of 131 Parachute Engineer Regiment and Sergeant Cyril Atfield of the Royal Army Pay Corps, both of whom were killed at Al Milah, 60 miles from Aden, South Arabia, in what is now the Republic of Yemen.
The deployment of 131 Para Regiment to South Arabia was the first time a Territorial Army regiment had been sent into conflict since 1945. In the engagement that led to the deaths of those men, five others were wounded and one officer was awarded an MBE for gallantry. It is surely undeniable that all the men were in a dangerous situation as a result of their service, but because of tight medal rules, none of the others involved in the engagement would receive a medal to acknowledge their service, unless they happened to be around long enough to receive one for long service.
I am not sure that that is accurate. They would qualify for the General Service Medal, Arabian Peninsula, even though they were killed within the 28 days, if their commanding officer put them forward for one.
I thank the hon. Gentleman sincerely for that contribution. I will speak about that particular medal, so his intervention is useful.
Much is said about the British medal policy being based on risk and rigour, but as Al Milah demonstrated, anyone who steps forward as a member of the armed forces may find themselves sent into a foreign land, sometimes to be woken at night by the sound of incoming fire. To me, that is self-evidently a dangerous proposition, and it certainly strikes me as enough risk to demand that we recognise it. However, this debate is not about an action or actions that took place a long time ago. It must be about what is right here and now, and that is what I hope that we can address.
One piece of correspondence shared with me relates to the action in Al Milah. It is yet another Ministry of Defence rejection of recognition for the service of Warrant Officer Lonergan, Sergeant Atfield and other members of the armed forces who placed themselves in harm’s way in Yemen at that time. The request was not for bravery medals; it was simply that they be awarded the General Service Medal with clasp South Arabia, which was awarded to other members of the armed forces in Yemen at that time. I am aware that my hon. Friend the Member for Midlothian (Owen Thompson) has been pursuing the case.
The letter from the MOD quotes Winston Churchill in 1944, in a debate about the medals to be issued at the end of the second world war. I have curtailed it for brevity, but I hope that Hansard will display the citation for Members’ benefit. He said that
“a distinction is something which everybody does not possess. If all have it, it is of less value…A medal glitters, but it also casts a shadow. The task of drawing up regulations for such awards is one which does not admit of a perfect solution…All that is possible is to give the greatest satisfaction to the greatest number and to hurt the feelings of the fewest.”—[Official Report, 22 March 1944; Vol. 398, c. 872.]
I argue that those points are as valid now as they were then.
I have a constituent called Glen who has been campaigning on this issue for many years. He was drafted through national service to serve as a non-commissioned officer in the Suez emergency in the 1950s, yet he feels that he has never received adequate recognition for the years that he dedicated to service and the sacrifice that he made. Surely we should do all that we can to honour those drafted to protect our country.
The hon. Lady makes a valuable point. There are many people in a similar position. They feel that they are being missed out, and that people do not understand or recognise what they have done.
The difference between my position and that of the MOD is that I believe we must take account of changes in context. As John Maynard Keynes said:
“If the facts change, I change my mind. What do you do, sir?”
I congratulate the hon. Lady on bringing this issue to Westminster Hall for consideration. She will be aware that there are many ex-service personnel who did not receive an operational medal during their service with the armed forces. Some of them were not on the front line: submariners on nuclear deterrent duty, for instance, or those in the Royal Observer Corps. May I make a plug for those in the Ulster Defence Regiment who served in Northern Ireland? Some of them also do not meet the criteria. There are a number of people I feel should be considered. Does she feel that the Minister should refer to them in his review?
I agree. I have been contacted by people who have served in many and various ways but are not entitled to a medal. It is an issue of concern, and I hope that we will hear more about it from the Minister. It does not matter how many independent reviews, staffed largely by people embedded in the status quo, take place; the changing facts provide the challenge facing the Government. The facts have changed. It is time that British medal policy changed to reflect them, and that it followed the example set by Commonwealth and other countries.
I congratulate the hon. Lady on securing this debate. She is absolutely right to say that many people are concerned about having their contribution recognised, particularly people who served in Northern Ireland and feel that they were not recognised for their contribution in the same way as people who served in more recent battles. I wrote to the Prime Minister on behalf of Robert Scollick, my constituent, and the Cabinet Office response said:
“I have to tell you there are no plans for further work on this issue, nor can I offer you a time scale when it might be sensible to return to this issue.”
I wish the hon. Lady luck in bringing to the Government the idea that the time to discuss it is now.
I agree that it is time to re-examine the issue. Things have changed. We must remember that our armed services are now made up entirely of those who have joined up voluntarily. They do so entirely of their own volition, and they clearly understand the potential peril that they face.
One of the other ways in which the context, and therefore the facts on which to base a decision, have changed involves the adoption of the armed forces covenant in 2010. On page 4, we find the commitment that performing any form of service in the armed forces deserves recognition and gratitude. Indeed it does, but unfortunately, for too many of those serving in our armed forces at present, we do not always deliver them. The armed forces covenant is mentioned often in this place, but such lofty words do not always translate into real and proper consideration of how we ought to support our service personnel and veterans.
Consider the recent poor outcomes of the armed forces continuous attitude survey, or the lengthy struggle to extract fair compensation for service personnel suffering from mesothelioma. The UK Government do not always do enough or act at an appropriate speed. A tangible recognition of service undertaken by means of a national defence medal would be only one way to continue to improve how we deal with our service personnel. We should surely be considering all our obligations.
Significantly, the most recent medals review, led by Sir John Holmes, recognised that the case for a National Defence Medal was worthy of consideration. I agree with him that such a decision would be significant and that it requires a broad political consensus; I am pleased to see a range of Members here. At the time of the review, the Committee on the Grant of Honours, Decorations and Medals advised specifically that the issue might usefully be reconsidered in the future, going so far as to consider how criteria might be applied for such an award. I do not propose to do so here, but I agree that the matter would have to be examined properly so that a clear award framework could be set out.
I am interested in the principle of a medal being awarded and that is what we should consider today. In the meantime, Ministers have agreed that the eligibility requirements for the Long Service and Good Conduct Medal, which is currently awarded only to other ranks and not to officers, should be harmonised in the future, and I hope that today’s discussion will be a way to further that debate.
Having examined the argument against a UK national defence medal, I found it to be thin and inconsistent. Medals are already awarded for service, or sometimes just for being somewhere at the right time. While some people with just 10 years of service may have two Jubilee Medals, I have been contacted by a former member of the RAF who served for 20 years but received no medal at all. It is impossible to argue that that is a coherent position. Many people leave the service with no medal while some people who joined in 2000 and left in 2012 have received two medals without seeing any operational postings. How does that policy address Churchill’s plea that recognition should
“give the greatest satisfaction to the greatest number and…hurt the feelings of the fewest”?—[Official Report, 22 March 1944; Vol. 398, c. 872.]
I congratulate the hon. Lady on securing this debate. Like my hon. Friend the Member for Beckenham (Bob Stewart), I am aware of the General Service Medal; in fact, I received one with a clasp for air operations in Iraq. However, I have a constituent who, as the hon. Lady just said, served in the Royal Air Force for 26 years in RAF Germany, during the cold war, which we could argue was a series of operations, without receiving a medal. So the hon. Lady has lots of support as she considers how we can recognise that type of commitment to our nation and our security with a national defence medal.
I thank the hon. Gentleman for that interjection; that story about his constituent is illustrative of the stories of members and former members of the armed services who have contacted me. There are people in so many different situations who fall down gaps that we perhaps did not realise were there.
How can this situation possibly be justified? If, as Churchill said, we want
“to give pride and pleasure to those who have deserved”
medals, is it any wonder that some people might consider that they are not being recognised equally? And is it any wonder if some former members of our armed forces consequently shun Remembrance Day events and other commemorative events? That concern has been raised with me and it is a great shame that some of those who have served, sometimes in very difficult situations, are not entitled to a medal, which causes them to be anxious about remembrance ceremonies. That is very unfortunate and entirely avoidable.
In the same 1944 debate that Churchill spoke in and that I have quoted, Leslie Hore-Belisha MP commented on exactly that kind of discrepancy in recognition. He said:
“The fact that such anomalies exist is no excuse for deliberately adding to them. It is the function of good legislation and administration to remove them and, if not to remove them, at any rate to diminish them.” —[Official Report, 22 March 1944; Vol. 398, c. 908]
That is what we should consider. The British Veterans National Defence Medal Campaign advances the simple and logical proposition that one way of diminishing such anomalies is to ensure that all members of the armed forces get the recognition they deserve for stepping into that role.
Other Governments have recognised this issue and acted to recognise the contribution made by their service personnel. The UK Government should now do the same, and acknowledge in this tangible way the work and the willingness to face peril that is common to everyone who signs up as a member of our armed forces.
I congratulate the hon. Lady on securing this debate. I am sure she will agree that when people sign up for the military, they sign up to put life and limb on the line for this nation, and for them not to have a medal that recognises that contribution is part of the insult, given that—depending on which operation they were involved in and what medals were awarded—they have made that core decision to put their life and limb on the line for the nation, which would be recognised by this medal we are discussing.
I entirely agree with the hon. Gentleman. That intervention absolutely gets to the crux of this issue. The Australian Government have recognised that point with their new defence medal, which was instituted in 2006, and they describe the purpose of that medal as being to recognise
“the outstanding contribution to our proud military history made by Australian men and women in uniform.”
That is all of them. Similarly, when New Zealand instituted its defence medal in 2011, the country’s Defence Minister, Wayne Mapp, described the basis for issuing the medal as follows:
“Many thousands of New Zealanders have met the demanding requirements of military service. They have served their country and community loyally and well...Up to now, there has been no recognition of this service, on which the Government places high value. This medal remedies that.”
That is exactly the type of recognition that I am looking for.
Here, however, the Ministry of Defence seems to place great store on the argument that a national defence medal would devalue other awards, which is an absurd proposition. When I asked a question about this topic at business questions recently, the Leader of the House of the Commons said he did not think that medals should be handed out in this way, and that the value of medals for particular examples of valour and service would perhaps be devalued by the issuing of a national defence medal. I could not disagree more. People who join our armed forces do so knowing that they are putting themselves into peril, and it is high time that we recognised that.
I believe that those who have been awarded medals for bravery do not feel that their awards are devalued because other colleagues receive the same campaign medal as they do, and nor would they feel that their awards were devalued by the receipt of a national defence medal. Those who were awarded a General Service Medal do not feel that it was devalued because others were awarded it, too. Arguments such as that made by the Leader of the House of Commons are simply camouflage for an unwillingness to listen.
Having already quoted Churchill, I will close my remarks today by doing so again, and this time I hope that the Government will pay particular attention to his advice. Writing on the conduct of negotiations between states, he advised:
“In war and policy one should always try to put oneself in the position of what Bismarck called ‘the Other Man’. The more fully and sympathetically a Minister can do this, the better are his chances of being right.”
I commend those sentiments to the Minister and I look forward to hearing how the Government intend to take forward the recognition by Sir John Holmes that the case for a national defence medal deserves proper consideration.
It is a pleasure to serve under your chairmanship today, Mr Stringer.
I congratulate the hon. Member for East Renfrewshire (Kirsten Oswald) on securing this debate. I am aware of the early-day motion on this issue that she has previously tabled, and I know, both from that and her comments today, how strongly she feels about it.
Her Majesty’s armed forces are the best in the world. Our service personnel have served Britain with honour, and are serving with honour at this very moment in many parts of the world. Their history is an inspiring story of courage, heroism and sacrifice, and it is because of our brave armed forces that we are protected. It is because of their inspirational work that our country stands safe, or at least as safe as any other country in the world. I take this opportunity to thank all those, both past and present—and, indeed, their families—who have served in our armed forces. This Government truly value their service. It was this Government who finally enshrined the principles of the armed forces covenant in law, to ensure that those who serve or have served, and their families, are treated fairly. The Government continue to work with businesses, local authorities, charities and community organisations to support our forces through services, policy and projects.
I am proud, for example, that we have committed to spend 2% of our national income on our military every year until 2020. We have also given over £450 million from LIBOR funds to military-related charities and schemes, and we are taking seriously the mental health of our veterans, launching a survey to try to understand their needs. We are providing mentoring, training and advice to our ex-servicemen and women through the veterans employment transition support programme, and we have invested £15 million to improve prosthetic services. We have given £20 million to eight projects to improve accommodation for veterans.
Let me now address the main point of today’s debate. Military honours and medals are one way, but only one way, that we can recognise the exceptional service of those brave men and women who go beyond even the high expectations of their comrades, commanders and country. It is vital for all who receive one that we do not devalue its importance.
Last year the right hon. Member for Broxtowe (Anna Soubry), then a Defence Minister, said that British military tradition dictates that
“medals are not awarded as a record of service but in recognition of specific campaigns or operations, acts of gallantry or outstanding service.”—[Official Report, 12 January 2015; Vol. 590, c. 587.]
I recognise that, but we already have a long service and good conduct medal, so would it not be in the best of British tradition to incorporate a national defence medal, in recognition of the service that good men and women of this country give to protect all of us?
I thank the hon. Lady for her intervention. It is true that we have a long service and good conduct medal, which was introduced as far back as 1830. It rewards other ranks who have completed 15 years of regular service, but not officers—I think it started at 21 years, and over time has come down to recognise those levels of service.
I will directly address the hon. Lady’s concerns later in my comments, but first I want to go back to something I have already referred to. Medals are one way, but not the only way, of addressing the concerns that some veterans have. Another method is memorials. Memorials are lasting public reminders and are places of pilgrimage for veterans and their families, the latest example of which is the memorial to Bomber Command, which was opened on 28 June 2012 by the Queen. There was a huge campaign for a memorial of that type. We also have the world war two memorial, the National Memorial Arboretum near Tamworth, which contains a number of other memorials, so we should not treat this issue in isolation. There are other ways of recognising the massive contribution that the military and their families have made to this country over many centuries.
Let me also say, however, that there is no simple way of doing that. It is impossible to satisfy all who have served their country. It is no easy task to set the limits or where the line falls for who receives a medal and who does not. There will also be disappointment on the borders of such decisions. The hon. Member for East Renfrewshire said that Churchill addressed the matter directly on the Floor of the House back in 1944, and she was good enough to put on the record part of what he said. I would like, however, to add the first part of what he said:
“The object of giving medals, stars and ribbons is to give pride and pleasure to those who have deserved them. At the same time a distinction is something which everybody does not possess. If all have it it is of less value. There must, therefore, be heartburnings and disappointments on the border line.”—[Official Report, 22 March 1944; Vol. 398, c. 872.]
Those words ring as true today as they did then, and in many ways the hon. Member for East Renfrewshire has today encapsulated the anguish involved in trying to make decisions that are fair to everyone. There will never be a perfect solution regarding the distinction between those who deserve medallic recognition and those who do not.
The Minister talks about those who deserve, yet the litany of those whom many would argue are deserving—from nuclear testing and Northern Ireland to suffering through front-line service in the cold war—should not be dictated by a debate on the Floor of the House of Commons in 1944, but by the lived experience of personnel who have served their country and the Crown with distinction, based on how we perceive our community today, not in 1944.
Of course what has happened since 1944 should not necessarily be dictated by 1944, but in that quotation Churchill summarised the issues and the anguish involved. I was merely trying to reflect that in my comments, as the hon. Member for East Renfrewshire did in hers.
Does the Minister agree that the slight difference between today and 1944 is that in 1944 adult men and women of a particular age were conscripted, under threat of imprisonment, at a time of war? What sets the veterans of today apart is that they volunteered to serve our country.
Of course there is a clear difference between what happened in the second world war and what happens today, but Churchill’s comments summarised the issues that needed to be carefully weighed up when making the decision. There is a strong lobby in the military for not making the changes, as well as the one we are getting from veterans about the national defence medal. The Government’s job is to try to make decisions about where the line falls in a fair and honourable way, and that is not easy. We will upset one group of people whichever decision we come to.
Although the Ministry of Defence instituted the armed forces veterans lapel badge in 2014 as a way of identifying all those who had done military service, it has never been the tradition here in Britain to consider service in the armed forces as the sole justification for a medal. It was right, therefore, that in 2012 the Prime Minister gave medallic recognition its appropriate attention, by commissioning Sir John Holmes, a retired senior diplomat, to review the awarding of military medals. I can assure hon. Members that great thought has already been given to all the points raised this morning. Sir John’s review team received more than 200 submissions and spoke to more than 50 people, including representatives of various veterans’ groups. Sir John independently reviewed a number of cases as possible candidates for changed medallic recognition, one of which involved Arctic convoy personnel and led to the Arctic convoy medal being given.
The national defence medal was worthy, as the hon. Member for East Renfrewshire pointed out, of full consideration in the 2012 review. Its supporters seek recognition for all those who have served, irrespective of where they were called upon to do so. The review estimated the cost of the medal at £475 million, and although it went far beyond the narrow consideration of cost, there would be implications for other activities and choices if the Ministry of Defence had to take that burden.
The Minister talks about the veterans badge. I am sure it must be clear—it has been mentioned in this very hall before—that the badge is not officially sanctioned and is therefore not a medal.
No, but as I made clear earlier, there are different ways of recognising the sacrifice that people have made for their country. Although the badge is not a medal, it is a recognition of service.
British campaign medals are not awarded as a record of service as in some other countries, but as a result of particularly difficult circumstances of service life—risk and rigour, as the hon. Member for East Renfrewshire said. Although some Commonwealth countries have their own equivalent of the national defence medal, namely Australia and New Zealand, the review felt that that did not present a strong enough case for us to do so. Sir John’s proposals were considered by the Committee on the Grant of Honours, Decorations and Medals, and the Committee could not see a strong reason for introducing such a medal at this time. Sir John published his final report in the summer of 2014.
The Government have taken unprecedented action to support our military, investing in areas from housing to social and medical care, and we will continue to do that. Unlike what happened under previous Governments, in recent years we have seen major investment in mental health, veterans’ accommodation and veterans’ hearing. We have seen multimillion pound investments in supporting our veterans, something done under no previous Government. We value all our military as brave heroes who keep, and have kept, our country safe, but following the most complete and far-reaching review of military medals for a generation, Sir John Holmes recommended not to introduce a national defence medal. That was no easy task, and I repeat what Churchill said: that there will be
“heartburnings and disappointments on the border line.”
Sir John’s review was published less than two years ago and, given that the circumstances remain exactly the same, we do not feel there is significant value in revisiting the matter. That position is not in any way intended to disparage those who have served their country. As I said at the outset, the Government have the highest regard for all those, past and present, who have served in the armed forces, and we will continue to do all that we can to support them.
Question put and agreed to.
HIV: Women and Girls
[Ms Karen Buck in the Chair]
I beg to move,
That this House has considered tackling HIV in women and girls.
It is a pleasure to serve under your chairmanship, Ms Buck. I start by thanking my right hon. Friend the Prime Minister, the Secretary of State for International Development, my right hon. Friend the Member for Putney (Justine Greening), and her ministerial colleagues for their ongoing commitment to international development and the 0.7% spending target, despite the best efforts of the august Daily Mail and other media. It is good to see that our ministerial colleagues remain firm in their commitment to international development.
As chair of the all-party group on HIV and AIDS, I called for this debate to provide an opportunity to reflect on the progress made and the challenges ahead in the response to HIV and AIDS and, in particular, in ending the AIDS epidemic as part of the sustainable development goals. I want to use the debate as an opportunity to press my right hon. Friend the Minister on the Government’s commitment to the SDGs, which were adopted in September 2015 by UN member states to galvanise efforts to meet the needs of the world’s poorest by 2030.
The final framework outlined in the agreed text contains 17 goals and 169 targets—it is not a brief document. One of those targets is:
“By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.
If the aim of ending AIDS as a public health threat by 2030 is to be achieved and if we are to bend the curve of the epidemic to manageable levels, the bulk of the progress must take place in the next five years. Without that, the epidemic could spiral out of control, and we can expect a spike in treatment resistance. Investment not made at this stage will lead to greater treatment costs at a later date. The joint United Nations programme on HIV—UNAIDS—agrees and has released fast-track targets. The 90-90-90 targets aim to ensure that by 2020, 90% of people living with HIV know their status, 90% of them are accessing treatment and 90% of those accessing treatment are virally suppressed. If we achieve that, the number of onward transmissions of HIV will be significantly reduced.
Meeting the targets is a stepping stone that will ultimately make it possible to end AIDS as a public health threat by 2030 and avoid an estimated 28 million HIV infections. The latest figures released by UNAIDS show that nearly 16 million people are now accessing antiretroviral therapy, or ARVs. That compares with the figure of 1 million 10 years ago. That is good progress. In 2014, there were 2 million new HIV infections, compared with 3.4 million in 2001. Those figures show that progress is being made, but they underline the need to do more.
I congratulate my hon. Friend on securing this important debate. Does he agree that unfortunately, as a result of stigma, prejudice and discrimination, many people with HIV and AIDS are driven underground and therefore do not seek treatment? We must do all we can to deal with that injustice and prejudice.
My hon. Friend makes good points. We often think of stigma and prejudice as affecting poorer parts of the world and, unfortunately, many parts of the Commonwealth, but stigma remains an issue even in the UK. Even in the UK, people seeking treatment for HIV will often go to a sexual health clinic outside their local area because they are afraid of the stigma that can be attached to being seen as being HIV-positive. We have made significant progress, but a lot remains to be done in the UK and in particular the developing world. My hon. Friend makes an important point.
There are still around 20 million people living with HIV who are not accessing ARVs. Just half of those living with HIV are simply not aware of their status. I want to talk about some of the key issues facing the AIDS challenge and the HIV challenge. Since 2000, adolescent deaths have tripled. AIDS is the leading cause of death for adolescents in Africa and the second greatest cause of adolescent deaths globally. Some 60% of new HIV infections are among young women. Globally, HIV/AIDS remains the biggest killer for women of reproductive age. More than 5,000 young women and girls acquire HIV every week. In southern Africa, adolescent girls and young women acquire HIV seven years earlier than their male peers, which has a devastating impact on their life chances. HIV/AIDS is a major barrier to the ability of women and girls to participate in education and to become and remain economically active. If we want to achieve gender equality across education, health and economic participation, we have to tackle HIV/AIDS in women and girls.
We know what needs to be done to achieve the target to end the epidemic by 2030. We know that we need to challenge and end the stigma and discrimination faced by those living with HIV/AIDS. That stigma acts as a barrier to people being tested and accessing the services they need. We need to improve access to treatment for those who are diagnosed as having contracted the virus. With just 25% of girls having a full understanding of how HIV is transmitted and prevented, we need to improve education. We also need to tackle violence against women and girls. Adolescent girls and young women who have experienced sexual violence are 50% more likely to have acquired HIV.
I commend the hon. Gentleman on securing this debate and on his chairing of the all-party group. Given that the highest incidences of HIV and AIDS among women and girls tend to be in countries with strong historical links to Britain, does he accept that we have a particular responsibility to show international leadership on the issue? Would this not be a good time for the Minister to announce that the Secretary of State will, as a result, be attending the 2016 UN General Assembly high-level meeting on ending AIDS in June this year?
The hon. Gentleman makes a strong point. It is still a shame on the Commonwealth that so many of our Commonwealth partners continue to discriminate against people with HIV and against lesbian, gay, bisexual and transgender people. Later, I will go on to mention some of the challenges with our withdrawal from many of the middle-income countries. It leaves many marginalised groups and many criminalised groups bereft of support, whether that is treatment or even just accessing healthcare in general.
On the Durban conference later this year, the hon. Gentleman will not have seen the answer to my written question that was published about 10 minutes ago, but the Department of Health will be sending ministerial colleagues to represent the UK and the Department for International Development is sending officials. The UK will be represented at the Durban conference—that is hot off the press.
Let me turn colleagues’ attention to some of the other issues. This is not just about the wide range of complexities, whether it is access to treatment, violence, education or economic participation; it is about how we approach research and development, both in dealing with HIV/AIDS and, in the developed world, in accessing the medical tools most needed to meet public health needs. The UK has an important role to play in meeting those ambitious objectives.
Historically, DFID has been a leader in the global response to HIV and AIDS and was viewed as one of the most forward thinking and effective agencies. When he responds, I am sure that my right hon. Friend the Minister will confirm how DFID’s research and development is progressing, so that we can ensure that our standing as a world leader in that field will remain. At one time, the Department had a large dedicated policy team engaged in the AIDS response. It showed financial leadership through increased funding of the Global Fund to Fight AIDS, Tuberculosis and Malaria, but I am concerned that its AIDS and reproductive health and rights team has gradually reduced in capacity and was renamed the sexual and reproductive health and rights team, with HIV being theoretically mainstreamed across DFID’s work.
There is increasingly a perception that DFID does not have the focus on HIV and AIDS that it once did. To be fair, every Minister I have spoken to in the DFID team, including the Secretary of State, has confirmed that HIV/AIDS remains a Government priority and an integral part of the Department’s work; yet the newly published UK aid strategy makes no reference to HIV or AIDS and gives no indication of how the UK intends to contribute to meeting the SDG target to end the AIDS epidemic by 2030. I checked the DFID website, and as far as I can see it appears to be silent on eradicating HIV as a departmental goal. It used to be a specific target and there used to be specific mention of what the Department was doing to eradicate HIV, but the website currently appears to be silent on that issue. Will my right hon. Friend the Minister explain why HIV has not been explicitly included and commit to putting that right?
When the hon. Gentleman researched the DFID website, was he able to find any speech by the Secretary of State or one of her ministerial colleagues on Britain’s contribution to HIV/AIDS that had not been provoked by a debate like this one, or by other House of Commons debates or questions?
To be fair, I did not search through all the speeches given by colleagues in the Department. I did see that the most recent targets and policy statements ended in 2015, when the SDGs were agreed, and that some of the other policy documents dated back as far as 2013. To be fair to colleagues in the Department, I am sure that they have made speeches, but I did not search the database. I was searching the targets and policy pages. I am sure that my right hon. Friend the Minister will be able to direct me to what I have missed, but it appears that the website is currently silent on specific targets and policies.
Can my right hon. Friend the Minister reassure me that he will ensure that the HIV response is given a clearer and explicit inclusion in the strategies to meet the needs of women and girls in order to support gender equality, as well as all the other related issues? Addressing HIV is a key component of the women and girls agenda, and I hope he will confirm that it will be made a specific target and policy of the Department and will be clearly and explicitly mentioned on its website. The lack of a clearly articulated HIV strategy sends out a signal that HIV is being deprioritised and absorbed into other areas.
DFID has put a lot of money into the global fund—I am sure that my right hon. Friend the Minister will confirm the amount, but it is something like £1 billion—which has done some great work in tackling AIDS and HIV. Government support for that sort of multilateral aid is very important. Does my hon. Friend share my hope that, following the multilateral aid review, investment in funds such as the global fund will continue to be significant?
My hon. Friend makes an important point. Our commitment to the global fund is outstanding—I believe we are its second-largest donor. My concern is that, because we are the second-largest donor, the global fund listens to the mood music from the UK Government. One issue that I have raised on many occasions is how our withdrawal of aid from middle-income countries, stopping much bilateral aid and moving through to multilateral aid, leaves many marginalised groups bereft. No transitional funding is put in place. We have started to see that kind of emphasis being reflected in the priorities of the global fund because it takes its lead from its major donors, which is understandable.
If the mood music coming from DFID is to deprioritise and, unintentionally, to leave marginal groups bereft, so the global fund will, perhaps by accident, also leave those marginal groups bereft, as it follows the UK lead in targeting non-MICs. I understand the strategy for MICs, but there is a significant risk that those groups that are most at risk in MICs are, through either cultural differences, stigma or criminalisation, left to fend for themselves. That cannot be a good outcome for the HIV/AIDS epidemic. I hope that my right hon. Friend the Minister will be able to address that.
It would be a catastrophic mistake to lose the focus on HIV/AIDS because we are on the brink of finally being able to control the epidemic as a public health threat. Will my right hon. Friend tell us how his Department is planning to meet the SDG target to end the AIDS epidemic by 2030, particularly for women and girls? What assessment has been made of the Department’s capacity to implement the target? The challenge of achieving universal access to ARV therapy remains ahead of us. As I mentioned earlier, something in the region of 20 million people living with HIV are not accessing treatment.
Last year the all-party group on HIV and AIDS conducted an inquiry into access to medicines that revealed some of the challenges that many low and middle-income countries face in accessing medicines. Treatment prices remain prohibitive in many countries. The price of treatments is primarily driven by licensing costs and decisions about what the market will sustain. Intellectual property rights grant exclusive rights to manufacturers that can make drugs without competition, which leads to high prices.
Affordable first-line treatments are now available in low-income countries in the form of generic drugs. That has been a major step forward in increasing access to treatments. However, the cost of second and third-line treatments remains prohibitively expensive, as such products are largely protected by patents, which keep the price high. Many middle-income countries are excluded from licensing deals that allow generic production, forcing them to purchase drugs at inflated prices. That restricts access to treatment. If a large proportion of people with HIV are women and girls, they will be excluded, because the health system will simply not be available or the treatments are too unaffordable to be universal.
International donors, including the UK, have been scaling back bilateral overseas development for MICs, thereby expecting national Governments to increase domestic funding. As I have mentioned several times, that leaves marginalised groups bereft of access to treatments, and some treatments will simply stop being provided.
I thank the hon. Gentleman for securing this extremely important debate. Does he agree that the issue is not only access to treatments but access to technology? During the Easter recess I was interested to read about portable methods for monitoring and assessing HIV. It is clear not only that joined-up thinking is needed across Departments—including Health and DFID—but that we should look at STEM subjects and our contribution to technological advances to ensure that people in rural communities have access to treatment through advances in technology.
The hon. Lady makes an important point. I visited South Africa and saw some of the work being done by Médecins sans Frontières in the townships there. What was interesting was that, despite the poverty, virtually everyone had a mobile phone. Many of the treatments, including the prompts to adhere to ARVs and other information, could be provided by harnessing technology. There is a huge gap that can be tackled, particularly in remote communities. Through the use of mobiles and other forms of remote technology, we have an opportunity to get information to people in remote areas and ensure that they have access to education and, if necessary, some form of treatment. Access to technology is a major challenge that colleagues in the Department for International Development can perhaps look at through the Global Fund.
We need to look the cost of new drugs. I hope that DFID can take a lead in looking at how the current research and development model prohibits access and innovation. Let me give an example about paediatric treatment. In South Africa and elsewhere, there is an absence of paediatric antiretrovirals. In the clinics in many of the townships of South Africa, doctors and nurses have to crumble the tablets and, almost through guesstimates, come up with a dosage suitable for the child or baby because paediatric antiretrovirals are not financially viable for the drug companies. The existing models work against providing universal access to ARVs and containing and defeating the epidemic. I believe that DFID can take the lead in looking at a way of de-linking the cost of research and development from the demands of profitability.
A proposal is under discussion to create a global R and D fund that would operate through a combination of grants, milestone prizes and end-goal prizes. If it were based on an open innovation-type approach, it could reward all those who have taken part, entered the process and contributed to developing the new treatment. That idea is not pie in the sky; it has not been developed by those who seek to undermine the pharmaceutical industry. That kind of development is championed by none other than the Prime Minister. In fact, the Conservative party manifesto contained a pledge—my right hon. Friend the Minister looks puzzled—that this country will
“lead a major new global programme to accelerate the development of vaccines and drugs to eliminate the world’s deadliest infectious diseases”.
I challenge colleagues in DFID to take the lead in looking at different ways of funding R and D to reduce the cost of second and third-line antiretrovirals. The Government have been generous in maintaining the 0.7% funding and in the money allocated for the global fight against malaria and the Ross fund.
Tackling HIV and AIDS in women and girls is a task we cannot shirk. It cannot and must not be subsumed into the main work of the Department and mainstreamed. We need explicit targets and action that we can hold the Government and Ministers to account on. I thank colleagues for attending today, and I look forward to hearing my right hon. Friend the Minister’s response and other colleagues’ contributions.
It is a pleasure to serve under your chairmanship for the first time, Ms Buck, and to follow the hon. Member for Finchley and Golders Green (Mike Freer), who gave a measured and constructive speech. I will try to continue that tone.
This debate is a timely opportunity to ask whether the Secretary of State and her ministerial colleagues have, perhaps inadvertently, downgraded the Department’s work on HIV and AIDS. Ministers rarely mention HIV and AIDS unless pushed. There is—granted, my exploration of DFID’s website was only cursory—no record of a serious ministerial speech on this issue unprompted by Parliament for a very long time. There is no sign of a push to signal Britain’s continued interest in the major international efforts to tackle the factors that still drive the spread of HIV and AIDS. Given the urgency of the investment that is needed if we are to achieve the 90-90-90 targets, which the hon. Gentleman spoke about, it is disappointing that the Secretary of State does not appear—unless the Minister has news for us—to have a major plan to do the advocacy work that is needed at an international level.
The 10 countries that had the most people living with HIV in 2014—the last year for which figures are available—are South Africa, Nigeria, Zimbabwe, Mozambique, Uganda, Tanzania, Kenya, Zambia, Malawi and Ethiopia. They are all countries in which DFID has a significant bilateral programme or with which our Government have a long history and good connections. Britain’s continued influence with the countries that have the most people living with HIV is unlike that of any other country in the G7 or globally. It is therefore all the more important that Britain continues to show leadership on this issue.
Similarly, the slightly different list of the countries with the highest incidence of HIV among adults, as opposed to the general population, comprises countries with which Britain has a close relationship at Government level or, with one exception, where DFID has significant programmes. Again, that highlights the importance of Britain’s role in galvanising further investment in antiretroviral programmes and in championing the legal and cultural changes that are necessary to improve the response to HIV and AIDS.
The Department’s work focusing on girls and women is important and very welcome, and it is strongly supported on both sides of the House and among the non-governmental organisation community. I commend the Secretary of State for that work. However, I continue to be surprised by the apparent lack of interest in the impact on women and girls of being HIV positive. HIV and AIDS continue to be the biggest single killer of women of reproductive age globally. Despite that fact, the impact of HIV on women as a priority group is not frequently discussed or reflected in ministerial policy.
The hon. Gentleman is making very important points about women and girls, but does he agree that they should be included as decision makers, not simply as victims and recipients of aid?
Absolutely. Britain’s international leadership on this issue is important because one of the things that we, as a country, should be championing is the cultural change that is needed in countries so that, as the hon. Lady says, women and girls become more active decision makers. At the moment, in too many cases, they are not. I gently bring her back to the important point she made about the strong support given by Britain to the global fund. I welcome that investment, but it is not enough to outsource leadership on HIV and AIDS from ministerial offices to the global fund. Political change is needed in countries as much as investment in health services, with which the fund helps. I fear that that is the important missing link in Britain’s response at the moment.
On 16 March, at International Development questions, I asked the Secretary of State specifically whether her Department’s spending on HIV and AIDS would be rising or falling over the comprehensive spending review period. In her reply, she said that the Department was planning shortly to publish the results of its bilateral aid review. Will the Minister set out for us whether he expects bilateral HIV-specific programmes to be rising, when up to now they have been in decline?
I am told by some of the NGOs that follow the Department’s work on HIV and AIDS closely that no mention of any such work seems to be in the aid strategy published by the Department last November. It would be good to hear from the Minister why that omission has happened. Furthermore, the sexual and reproductive health team, which has responsibility for HIV and AIDS work—certainly on the basis of ministerial answers to written questions—appears to be prioritising a series of other issues. They are very important issues, granted, but they are issues other than HIV and AIDS. Again, it would be good if the Minister explained that choice to downgrade the work on HIV and AIDS by the sexual and reproductive health team in DFID.
I come back to the first intervention that I made on the hon. Member for Finchley and Golders Green. He mentioned the Durban meeting, but I gently suggest that the UN General Assembly’s high-level meeting on ending AIDS, which is to take place in New York in June, is equally important. That is surely the perfect opportunity for the Secretary of State to set out Britain’s continuing commitment to and willingness to play a significant leadership role in tackling AIDS.
In addition, Britain could ask the new Commonwealth secretary-general to prioritise a discussion of the work needed in Commonwealth countries to tackle the HIV and AIDS epidemic. Foreign Office ambassadors and senior staff could perfectly reasonably be tasked to talk to senior figures about what more might be done in countries with particular challenges in tackling AIDS.
I thank the hon. Gentleman for his generosity in giving way. At those various international meetings, global ministerial commitments to tackle issues such as forced marriage and early marriage are also key factors in fighting HIV and AIDS.
The hon. Lady is absolutely right. A series of factors drive the spread of HIV and AIDS. A health response is needed—we have rightly talked about the need to invest more in antiretroviral AIDS therapy and to improve health services more generally. A series of cultural practices need challenging and gender empowerment issues need addressing.
The only way that such things can happen is if political leaders are willing to step up to the mark. The challenge needs to come from a country such as Britain that has shown great leadership on the issue in the past; we will work with and support them, but we want things to change. I hope that the Minister will reassure me that the Secretary of State is willing to show that kind of leadership in future.
It is a pleasure to speak in the debate and to serve under your chairmanship, Ms Buck.
We are discussing HIV, which curses the lives of people in all walks of life across the globe. Yet many of the women who are infected are unaware of the status of their condition and are unable to access the treatment that they rightly need to go on to live a long and sustained life. I thank the hon. Member for Finchley and Golders Green (Mike Freer) for securing this debate on tackling HIV and AIDS specifically in women and girls.
Perhaps due to the lingering stigma attached to HIV since the time of the virus’s discovery more than 30 years ago, its impact on women is often disregarded in policy. Recognising that the barriers, stigmas and issues of access to services and treatment all require further consideration, let us use today’s debate to turn the trend on its head—we must recognise that, globally, HIV is the No. 1 killer of women of reproductive age.
We must also recognise the UNAIDS 90-90-90 target, which we heard about from the hon. Gentleman: the ambition by 2020 to have 90% of all people living with HIV knowing their HIV status; 90% of all people with diagnosed HIV infection receiving sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy having viral suppression. That should be not only an ambition but a reality, and we must ensure that we do all that we can to make that the case.
There are, without doubt, issues of HIV infection among women in the UK, but the heaviest concentrations of HIV infection are in the developing world. In such places, women are most affected. In sub-Saharan Africa, the region with the highest burden of HIV, 57% of people living with HIV are women, and figures from 2014 show that, among women of all ages, there were 12,500 new HIV infections every week. Those figures are huge. The effect of infection on each life is devastating; the lives of young girls, future women, will be devastated unless we do more to act. We must ensure that the UK plays a prominent role in securing a future for them. It is vital to consider how aid programmes funded by the UK and the devolved Governments can help to change that deadly trend.
There is a correlation between disproportionate rates of HIV infection among women and gender inequality. Gender inequalities have far-reaching consequences for women living with, and at risk of, HIV. To name but a few, issues include domestic violence, the role of sexual violence and the lack of access to income and property. Only last month, with the Women and Equalities Committee, I visited the UN Commission on the Status of Women, which focuses primarily on women’s economic empowerment. We must ensure that we unpick such gender issues and learn how best to tackle them. I ask the Minister how DFID intends to monitor and track the progress of sexually transmitted disease and to set targets for achieving those goals. The disease will not disappear by itself, and ultimately we must do all that we can to end the epidemic.
Advances have been made to improve access to antiretroviral treatment, but socioeconomic barriers for women to overcome remain. In particular, UNAIDS research identifies food insecurity as a barrier to adherence to antiretroviral therapy. Without adequate dietary intake, people undergoing antiretroviral therapy cannot experience the full benefits of treatment. That can create a vicious cycle. Women are usually those involved in producing, purchasing and preparing food. When a woman is HIV-positive, household food security is impacted as responsibilities shift to the younger women in that household, often raising additional issues of food insecurity for their families.
It is believed that 90% of HIV-positive children contract the virus from their mother during pregnancy, delivery or breastfeeding. Inadequate nutritional status may increase the risk of HIV transmission, and women therefore need access to information and replacement feeding options to minimise the risk of transmission during breastfeeding. It is unacceptable that the number of women and girls contracting HIV infections continues to be a growing trend, especially in developing countries. Young women aged between 15 and 24 are five times more likely to be affected than young men of the same age. The problem of HIV in Africa is complicated and there is no magic bullet. However, we must do more to educate men and boys about how they can prevent this disease, so that we prevent such harrowing statistics. Adolescents between 15 and 19 make up 74% of the new HIV infections that affect young girls and women.
The Scottish National party believes firmly that the empowerment of women is key to tackling and battling global poverty, and we are not alone. The First Minister is quoted as saying that the SNP sees the empowerment of women as the key in battling global poverty. Scotland’s First Minister has said:
“For virtually every nation, fully empowering women is probably the single simplest way, in which they can sustainably increase their productive potential. Gender equality can help to transform the global economy.”
The World Bank has said:
“Putting resources into poor women’s hands while promoting gender inequality in the household and in society results in large development payoffs.”
The UN General Secretary has said that
“removing the barriers that keep women and girls on the margins of economic, social, cultural and political life must be a top priority for us all—businesses, governments, the United Nations and civil society.”
The Scottish Government have taken action where possible to help the world’s most vulnerable people through their small grants programme. This programme supports NGOs to make a big impact and reduce poverty worldwide. The grant also includes using community sport to educate young people about HIV and using technology for a mobile phone app to improve emergency care in Zambia.
The HIV crisis is impacting developing nations, but it can be stopped. In order to best contribute, UK aid must focus on education about HIV transmission and on empowering women who are at most risk of infection. I urge the Minister to consider the effects of HIV on women and girls. How does the Department intend to monitor and track its progress in achieving the sustainable development goals? It is the responsibility of all Governments wherever possible to provide leadership in this debate. I hope the Minister will be able to respond to my questions.
It is a pleasure to speak in this debate and I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing it. Many of us have an interest in this issue. I suspect that many more would be here if it was not for other duties and debates elsewhere, because the issue certainly resonates with us. We are here today because we want to highlight the issue for those in other parts of the world. We are taking steps here in the United Kingdom of Great Britain and Northern Ireland, but we need to encourage countries and Governments to take steps elsewhere.
Worldwide there are some 900 million adolescent girls and young women in the 15 to 24 age group. Despite being 12% of the entire population of the world, too often for cultural or political reasons those young women are left without a voice or any say or control over their own bodies. We are all aware of the issues across the world and the violence against women. Rape seems to be a method of violence and war that some soldiers inflict on women wherever they have the opportunity to do so. We have had many debates in Westminster Hall that have highlighted the rape of women and girls and the brutal, horrible violent acts that take place against them. We recently had a debate on Burma and the Rohingya people.
Across the Sahara and across Africa, rape seems to be a weapon of war and we must highlight this issue. I often say we have to be a voice for the voiceless, and so we do. In this House we have to be a voice for those who have no voice, who do not have anyone to speak up for them, and the debate today is an opportunity to do just that.
Women have limited access to healthcare in developing nations and little or no access to education. Systems and policies skewed against them in some of the more gender-oppressive nations combine to create obstacles that block adolescent girls and young women from knowing how to and being able to protect themselves against HIV. We need a loud awakening of some of the Governments across the world so that they understand what is going on.
Despite the fact that the world is becoming more global, there are still regions in the world where young women and adolescent girls remain at a much higher risk of HIV infection than their male counterparts. It is shocking that, despite this fact being known, there seems to be no real progress, and girls in the age group I referred to still account for a disproportionate number of new infections among the young people living with the infection. There are an estimated 340,000 to 440,000 new HIV infections among young women aged 15 to 24 each year. If that does not shock us, I do not know what does. Despite making up only 12% of the population, they accounted for 60% of all new infections.
Poverty plays a big role, but the elephant in the room, as so often, is that although it is a global issue, there are clear issues in particular regions that exacerbate the case. It is true that some cannot afford access to care, treatment and preventive measures, but more often than not it is the cultural or political treatment of women that means they are unable to access the treatment, care and preventive measures that they need. Fifteen per cent. of women living with HIV are aged 15 to 24, a shocking 80% of whom live in sub-Saharan Africa. We know that that is an extremely impoverished area of the world, but we also know that the culture and policy towards women there is a far cry from the relative gender equality we enjoy here in the west.
Indeed, up to 45% of adolescent girls in those poor regions reported their first sexual experience to be forced. That is another shocking statistic. It is estimated that around 120 million girls worldwide have experienced rape or other forced sexual acts at some point in their life. The magnitude of those figures should shock us all. They remind each and every one of us exactly what the issues are and it is why this debate is so important. From a collection of more than 45 studies from sub-Saharan Africa, it was revealed that such relationships were common between younger women and older male partners, and relationships with large differences in age are associated with unsafe sexual behaviour and the low use of condoms.
Women who experienced violence from a partner were 50% more likely to have contracted HIV than women who had not experienced such violence. In fact, of all the age groups, even married girls and women in the 15 to 24 age group are most affected by spousal physical or sexual violence. Some of the Members who have spoken already, including the hon. Member for Lanark and Hamilton East (Angela Crawley), who spoke just before me, mentioned DFID. Again, the background notes supplied for this debate are very helpful. I want to put this note on the record:
“DFID has committed to putting girls and women at the heart of its development assistance. As well as continuing a focus on women and girls in DFID’s bilateral HIV programmes, more work is required to capture, measure and maximise the HIV related benefits of DFID’s wider work with women and girls.”
Hon. Members who have spoken have expressed some disquiet over the DFID policy in relation to its ever being successful. The Minister always responds in an energetic and knowledgeable way, so I am sure he will be able to indicate and reaffirm DFID’s response. If there is a shortcoming—I perceive that there is—DFID must address that as well.
The note continues:
“Global progress on reducing new infections in women and girls remains a priority for DFID.”
I hope that that is the case. Negative gender stereotypes and harmful norms are equally damaging. Adolescent girls and young women face significant barriers in accessing health services or protecting their own health. Lack of access to comprehensive and accurate information on sexual and reproductive health means that adolescent girls and young women are not equipped to manage their sexual health or to reduce potential health risks. Furthermore, they are less able to negotiate condom use. They have limited access to HIV testing, modern contraception and family planning, and are less able to adhere to HIV treatment. Those facts cannot be ignored.
Queen Nana Adwoa Awindor of Ghana, who chairs the African Queens and Women Cultural Leaders Network, has underscored the important role that cultural and traditional leaders have to play in the fight against HIV and AIDS, saying:
“It is our responsibility to ensure that harmful traditional practices that promote the spread of HIV such as early marriages and female genital mutilation are eradicated”.
What she is saying is, “Change traditions and protect the people.” I hope that today’s debate will in some way do that.
ln sub-Saharan Africa, only 26% of adolescent girls possess comprehensive and correct knowledge about HIV, compared with 36% of adolescent boys. In that context, according to UNICEF, among girls aged 15 to 19 who reported having multiple sexual partners in the previous 12 months, only 36% reported that they used a condom the last time they had sex. There are basic, simple issues that must be addressed by DFID and through the Minister’s Department, but also by the Governments responsible for the countries where HIV and AIDS are epidemic. There is a need for relentless pressure to be exerted, using the international bodies at hand, such as the UN, on the Governments of the countries in question. The things I have talked about are not acceptable in the UK, and we are addressing them; they should not be tolerated anywhere else in the world.
It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing what has been a considered and useful debate on tackling HIV and AIDS in women and girls. I congratulate him too on his work as chair of the all-party group on HIV and AIDS, of which I am a member. There were useful contributions from the hon. Member for Harrow West (Mr Thomas), who brings considerable experience to the debate, my hon. Friend the Member for Lanark and Hamilton East (Angela Crawley)—I shall reflect in particular on some of what she said—and the hon. Member for Strangford (Jim Shannon), who spoke of being a voice for the voiceless. I do not think there is any question of his voice not being heard. He spoke with his usual commitment and passion.
This debate is timely, as has been mentioned, taking place as it does in the context of the adoption of the sustainable development goals. Indeed, some of us will be back tomorrow for a debate on the implementation of those goals in the round. However, today’s debate is a useful opportunity to reflect on the particular issue of tackling HIV and AIDS, for all the reasons that we have heard, in particular the need to make rapid progress now that the goals are agreed. The number of people around the world living with HIV and AIDS continues to rise, despite the progress being made, and indeed partly as a result of it, given the enhanced longevity from treatment—an HIV infection need not be a death sentence per se. Nevertheless, transmission continues to increase and, as we have heard, in particular parts of the world that may affect women and girls disproportionately.
Three themes arise from what we have heard in the debate: general issues and challenges, such as those I have touched on; the steps and strategies needed to tackle those challenges; and the ways in which we fund and prioritise those steps. I will reflect briefly on those, making sure, of course, that the Minister has plenty of time to respond to all the questions that have been asked.
We have heard that HIV/AIDS is the No. 1 killer of women of reproductive age around the world. In our part of the world it is sometimes difficult to comprehend that, because it is not necessarily true in every individual country, or in developed countries such as ours. However, in developing parts of the world it is of particular concern. During the recess I was in Zambia with the Westminster Foundation for Democracy. The overall prevalence of HIV/AIDS in the country is 12.4% of the population—some 500,000 women. Yesterday I welcomed Jacqueline Kouwenhoven, who is Dutch born but is a Member of the National Assembly of Malawi. She is the Member of Parliament for the Rumphi West constituency. In Malawi the prevalence of HIV/AIDS among men is 8.1%, but among women it is 12.9%. That is a pretty stark demonstration of the disparity, and the disproportionate impact that HIV/AIDS has on women, which is reflected in other statistics we have heard in the debate. I think others have discussed how 74% of new HIV infections in 2014 among adolescents in Africa were among girls and women. That is 12,500 new infections every week, and it gives us a sense of the scale of the challenge.
There is a challenge in two respects. First, there is a challenge for the individuals, as HIV/AIDS limits their life chances and lowers their life expectancy, limiting their ability to work, contribute to society and live flourishing, dignified lives of their own. However, there is also a broader development challenge, in the form of a barrier to societal and economic development, starting at household level, because younger children may be taken out of school to provide care or take up income-generating activities. That has a knock-on effect on whole societies. My hon. Friend the Member for Lanark and Hamilton East quoted Scotland’s First Minister, Nicola Sturgeon, on the importance of empowering women fully, as the simplest way for countries to increase their productive potential sustainably. Interestingly enough, the quotation came from a speech given to the Chinese Friendship Association in Beijing in July 2015. As we have come to expect, Nicola Sturgeon is not afraid to be a voice for the voiceless and to speak out, without fear or favour, around the world on issues of gender equality. That goes to the heart of the point made about the need for political leadership—both an holistic response to a holistic challenge, and political leadership to drive that response forward.
The steps needed to tackle the spread of HIV and AIDS among women and girls in particular fall into two key areas. The first is prevention, in its broadest sense. We have heard a lot in the debate about education, including education specifically for awareness—of status, safe practices and cultural barriers. All those things are important, and we have heard about some of the support that the Scottish Government are providing. A particularly interesting example came about through the small grants scheme, which allows the funding of small, innovative programmes. The Yes! Tanzania programme conducted a feasibility study on using its sports facilities to educate young people about the transmission of HIV and AIDS, and used the study to put the lessons into practice. It will deliver both sport and sexual health training to more than 60 community sports coaches, teachers and peer leaders, and through that method will reach more than 2,000 young people in Arusha in Tanzania. Hopefully it will go on to measure the impact of the work.
Using small grant funding can be a useful and innovative way to try out new techniques and to reach young women and men in particular, through forums where they might not traditionally have expected to receive such education. It would be useful to hear the Minister reflect on whether there any lessons he can learn from that kind of thing.
I would like to reiterate what the hon. Gentleman has said. The Elim Church in my constituency—to give just one example—does fantastic work in Swaziland with young boys and girls who have HIV/AIDS. Some of the good work that the hon. Gentleman has been discussing, and that he asks DFID to do, is also being done by church groups throughout the United Kingdom. I mentioned the Elim Church, but the Presbyterian Church, the Church of Ireland, the Methodists, the Baptists and the Roman Catholic Church all do it as well. It is good to recognise some of the good work that other groups do.
I am sure we can all give examples from our constituencies or broader areas of interest of specific projects or programmes that have made a difference. An issue relating to some of the broader questions that have been asked about DFID is to do with its different priorities: the way in which it is leveraging the 0.7%, which we all welcome, and how that can be done as effectively and as holistically as possible. Having some flexibility to try to innovate in new areas and support small, dynamic projects is definitely one area for consideration.
There is the important question of education specifically about HIV/AIDS, which we have heard about, but there is a broader question of education as well. Although it is true that, as I have said a number of times—my hon. Friend the Member for Lanark and Hamilton East said it too—there is no silver bullet to global development, educating women and girls is about as close as we can get. Broader access to education—not just education on HIV/AIDS but, more broadly, education that trains and empowers women with the skills they need to take into society—can reverse the negative spiral that I spoke about at the beginning of my remarks. That economic empowerment is crucial.
I want to highlight again the need to educate men and boys on their role as community leaders, partners, fathers and brothers, because they also have a role to play in education.
Indeed. Speaking from my 36 years’ experience as a man, I entirely agree about the need to tackle all these issues. Education, in a range of different forums and of both men and women, is important.
Access to treatment is also crucial. It has been interesting to read in some of the documents supplied in preparation for the debate about the progress made in terms of prophylactic and preventive treatment such as the dipivirine ring trials and various other medical advances, which are incredibly encouraging. It is important that they are invested in and supported. That is why the points made, especially by the hon. Member for Finchley and Golders Green, about intellectual property in the development of pharmaceuticals is key. That has come up in numerous Westminster Hall debates on international development, in particular on tackling preventable disease. It would be interesting to hear from the Minister how the Government intend to take forward those proposals—I was interested to hear that movement in that direction appeared in the Conservative manifesto.
Just as with education, where specific education and improvements in education across society as a whole is needed, the same is true in treatment. We need to be able to treat the specific symptoms, effects and infections and boost the overall level of wellbeing of society as a whole. That is where questions of food security and so on come in.
In addition to a medical model, does my hon. Friend agree that it is extremely important that couples counselling is also offered to help in coming to terms with HIV diagnosis, reducing stigma and the risk of violence and desertion by a partner, and ensuring that adaptive coping strategies are applied?
That is a useful point. My hon. Friend brings considerable experience of those issues to the debate, so it is useful to have her contribution.
That brings us to funding and prioritisation. I generally echo all the questions directed at the Minister so far. On the prioritisation that DFID is prepared to give to the sustainable development goals, every credit is due to the Government for the role they played in the negotiation and establishment of those goals, which are a hugely comprehensive framework for global development. We now have a road map that can take us to the kind of world that we know is possible, which will allow us to reach other targets such as the 90-90-90 target, which has been referred to. However, I do not think I am alone, even in the Chamber, in being slightly disappointed by the lack of emphasis given to the sustainable development goals in the Command Paper, for example, or the lack so far of a joined-up Government approach or even of information about that. Indeed, my hon. Friend the Member for Lanark and Hamilton East raised questions about monitoring.
Other mechanisms also need to be considered. The Global Fund is due for replenishment, so it would be interesting to hear a timetable from the Minister for the Government’s commitment. They have said repeatedly that they are prepared to give up to £1 billion, so my question has repeatedly been: if they are prepared to give up to £1 billion, why not just give £1 billion? The Global Fund knows how much money it needs and the UK has an opportunity to show global leadership by committing as much as it can to that replenishment.
Finally, the point about middle-income countries is crucial. I spoke about Zambia earlier on, and the definition of a middle-income country stretches from a GDP per head of something like—I do not have the figure in front of me—$1,500 to $13,000. In that vast range, a country can suddenly become a middle-income country and find itself less able to access the resources and support that helped it to attain that status. It would be interesting to know how the Government intend to support countries as they transition to middle-income status to reduce the risk of back-sliding in so many areas, not least HIV/AIDS transmission.
HIV is a preventable and treatable disease and we have the knowledge and ability to reduce transmission and improve access to treatment, especially with regard to women and girls. If we do that, we boost development, help to build stable societies and grow economies. Everyone benefits, but we must have the political leadership and willingness to invest effectively.
Let me first say what a pleasure it is to serve under your chairmanship, Ms Buck. When we first met 30 years ago, giving out leaflets on the streets of Paddington, who would have guessed that I would be my party’s spokesperson on development, but you would be a member of the august Panel of Chairs?
Let me congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing this important debate. Let me say a word about the position of women and girls in the UK and remind the House that the part of the population with the most disproportionate incidence of HIV/AIDS is African women. The reason they have that level of infection is because if people think the level of stigma in the population as a whole against HIV and AIDS is bad, for men who have sex with men in the African community it is so much worse. It is all about stigma, so anything we can do in this Chamber to break down that stigma will save lives not just in the global south, but in communities in some of our constituencies.
As we have heard, the number of women and girls living with HIV continues to increase in every region of the world. As a group of politicians, we should pause and think about what that means to people’s lives and hopes. This is not just abstraction and about position papers; it is actual people’s lives. Last year I was privileged to visit Uganda on a wonderful trip, organised by the Aids Alliance and Stop Aids, to meet the men and women working on Uganda’s HIV/AIDS response at Government level, at non-governmental organisation level and at grassroots level. It was an amazing trip.
I visited 10 different projects in all during my time in Uganda, but three stand out. One was a project involving the Lady Mermaid Bureau and Crested Crane Lighters. This was a project for female sex workers—actually, we could not consider those women victims. We went to the market where they plied their trade. They spoke to us about their fears, their experience of police harassment, their hopes, their efforts to get information and protection to younger sex workers, and their hopes for their children. This is the sort of grassroots project among a marginalised community that is so important to fund and support if we really are to roll back HIV/AIDS in those communities.
I also met the Uganda Youth Development Link, which is a genuinely young persons-led project—the chair was 28 years of age. It is a network of young people from 10 to 30 living with HIV/AIDS, and they pointed out that one of the problems with HIV response in the global south is that it does not reach young people: it is not reaching under-18s; the work is not being done in schools. In what are very young societies, if we are not focusing on under-18s or doing the work in schools, we are not doing what we need to do to reach the goal of eradicating HIV/AIDS.
I saw many projects in Uganda, and my trip brought it home to me that, in the end, it is not about what we say here in this House. It is not even about what the big NGOs and the UN can do. It is about communities and empowering people—particularly women and those in marginal communities—to offer leadership and to roll back this scourge.
We have made a great deal of progress on HIV/AIDS, but it is important that we do not roll back on that progress now that our goal of eradicating altogether is within sight. I hope the House will forgive me if I remind it of Labour’s record on this issue. We have continued to be a champion in the AIDS response, leading the first global promise to deliver universal access to HIV treatment, care and support by 2010 at the 2007 Gleneagles G8 summit.
The Government are to be applauded for their contribution to the Global Fund, which has disbursed $27 billion on programmes for HIV, TB and malaria, and programmes supported by the Global Fund had saved 17 million lives by the end of 2014. However, there is a concern about bilateral spending and the absence in the Government’s programmes and policy of a specific commitment on HIV/AIDS. Commendable as the Global Fund and the Government’s support for it are, bilateral aid for HIV continues to be important to meet the gaps that the Global Fund cannot fill and to equip affected communities—whether it is the young people or the brave and vibrant sex workers I met in Uganda—with the skills, tools and information they need to help the Global Fund to meet its goals.
Sadly, it would appear—I am content to be put right by the Minister—that UK bilateral funding for HIV has been decreasing, and many are concerned that it may come to a complete end. I would stress to the Minister that we cannot end aid dependency or stop thousands of lives being lost to AIDS month by month in regions of the world if we do not equip communities, including marginalised ones, with the tools to tackle and treat HIV/AIDS.
We need to build the capacity of communities to demand their rights. Ending AIDS by 2030 requires investment in communities and support to demand their rights, and the evolution of the Global Fund clearly demonstrates the value of such investments. There are still challenges in ensuring that key populations—for example, LGBT populations or sex workers—have a voice, but the Global Fund has developed strong human rights principles and places a value on the inclusion of those populations in governance structures. That evolution is driven by the affected communities, but it needs strategic bilateral funding.
As colleagues have said, the sustainable development goals have committed to ensuring that no one is left behind. The UK Government, in their new aid strategy, have committed to leading those efforts. Delivering on that promise, however, will require ensuring that those who are most marginalised, vulnerable and excluded can benefit from efforts to deliver the SDGs, including the goal on ending AIDS. The Global Fund cannot achieve that alone.
We have to consider the practicalities. I saw in Uganda last year that condom use—which is not a high-tech medical intervention, but a vital one—in the global south has gone down. There has been an increase in new infections, and under-18s are not yet a target group. Forty per cent of the Ugandan population are under 30 years of age. That very high proportion of young people is true across the global south, and one challenge faced by groups seeking to work on HIV/AIDS is the rise of vicious anti-human rights legislation on homosexuality and the LGBT population. In Uganda, we found that that was a major obstacle in the communities that needed to be reached.
I will mention one more group that I met in Uganda. Icebreakers Uganda is a youth-led LGBTI organisation that we visited in Kampala. Think what it means to be an LGBTI organisation in a country that has passed legislation that could end up with people losing their lives for admitting to being LGBTI. Despite the challenges, the organisation offers services in 14 districts in Uganda, runs a 24-hour service and has a house and centre for men who have sex with men. Due to the punitive legislation and criminalisation, the organisation has to be very careful about how it works, but it continues to work.
I commend the Government for their contribution to the Global Fund. It is unfortunate, as we have heard, that we have only promised 80%, not 100%, of what we should be providing. I stress the importance of making HIV/AIDS a specific goal and a specific issue in relation to women and girls. The Government cannot expect to be taken seriously in their concern for women and girls if the issue of HIV/AIDS is not only high up the agenda, but explicitly so in the speeches that are made, on the Department’s website and in the availability of funding.
It is a great pleasure to follow the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who spoke with infectious enthusiasm about her experiences in Uganda, the programmes she saw there and the genuine commitment to community empowerment.
I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for focusing his forensic intellect and our attention on this vital life-and-death question, on the eve of the replenishment of the Global Fund, with the UN’s high-level meeting on ending AIDS and this year’s AIDS conference coming shortly thereafter. This is a year in which we must make a change in the trajectory of this disease with respect to women and girls.
I clearly have to reassure my hon. Friend. I do not believe that this is the best forum in which to take him through the Department’s website, but I am confident that we can arrange a time to do so, perhaps when there is a screen in front of us. On the goal that he found absent, the high-level departmental goals will not specify every disease upon which we want to make an impact. I put it to Members this way: we put our money where our mouth is—follow the money. We are the second largest donor in the world in response to the AIDS epidemic.
In 2014-15, we spent some £374 million on our response to AIDS. In the current cycle, we have committed £1 billion, subject to the 10% burden share, to the Global Fund. We support UNAIDS, UNITAID, the Clinton Health Access Initiative and the Robert Carr network for outreach to civil society. All those things are vital, and they have had an impact. The response to the AIDS epidemic has seen in the past five years 15 million adults being treated for the disease, 1 million babies of infected mothers being able to avoid infection themselves and a two-thirds reduction in the number of new infections—and yet, as my hon. Friend pointed out, in sub-Saharan Africa 50% of the people who are infected do not know it, and among young women, only 15% know they are infected. Clearly, this has to be our main effort if there is any prospect of us getting to zero: to zero new infections, zero—
I am sorry. The hon. Lady has rather thrown me—I give way to her, if she must.
I apologise for interrupting the Minister’s flow, because he is making a very important speech. I have listened carefully to the debate, which I commend the hon. Member for Finchley and Golders Green (Mike Freer) for securing. I agree with my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), the shadow Secretary of State, that because of what the Minister is saying, the Government should be very clear that that is their aim. I still do not understand why they have not explicitly stated it in their information. I hope he is coming to that point.
I hope that I will be given the chance to get there, and that my statement today will be regarded as something of an explicit statement in lieu of what Members have not been able to find on the website, but that is a question we might come back to.
As I was saying, this has to be our main effort if we are going to have any prospect of getting to zero: to zero new cases, zero deaths and, as the hon. Member for Hackney North and Stoke Newington and my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) pointed out so importantly, to zero stigma and discrimination—a vital part of the equation.
How are we going to achieve that? I believe that the proper principle is to deploy our resources where the need is greatest, where the burden is greatest and where the resources are fewest. I have to reassure my hon. Friend the Member for Finchley and Golders Green in respect of his perfectly proper concern about middle-income status countries. The reality is that the Global Fund deploys half its resources in middle-income countries and specifically has programmes to deal with neglected, vulnerable populations in high middle-income countries. We have given £9 million to the Robert Carr fund specifically to address some of those issues.
I put it to hon. Members that as countries develop and become wealthier—I accept entirely that, as the hon. Member for Glasgow North (Patrick Grady) pointed out, there is a question of what defines a middle-income country, and there is a wide spread—there has to be an expectation and a challenge to them to start deploying more of their resources to deal with the problems of healthcare and AIDS in particular. It is very much part of the Addis agenda that countries deploy their own resources, and part of the challenge to us and to the Global Fund is to hold them to account for doing so.
My hon. Friend the Member for Finchley and Golders Green was right to challenge me on the issue of research and development. I do have concerns, but we are the leading investor in product development partnerships, which delink the market incentives for research and development and replace them with the prioritisation of public health objectives. Some 11 new products are now on the market in low-income countries as a consequence of the partnerships that we have developed. In addition, we have invested. We are the fifth largest funder of UNITAID and have put €60 million into its programme for developing diagnostics and treatments. Indeed, there is also its groundbreaking development in the treatment of paediatrics, with some 750,000 treatment regimes for children.
I agree with the Minister that as countries get wealthier, in principle they should take responsibility for their own HIV/AIDS programmes. However, when there are allegedly middle-income countries that are members of the Commonwealth but which, to all intents and purposes, are going backwards on LGBT rights, does Her Majesty’s Government not have a responsibility to intervene with the type of projects that would make it easier to access marginalised communities?
I accept entirely that there is a challenge to all the developed world and all right-thinking countries to hold those regimes to account for their treatment of human rights and respect for human rights. Nobody should be left behind—that is the principle that we have to abide by—and we must find programmes and measures to deal with that. I accept that the hon. Lady is right on this issue.
On the issue of research and development, we are alive to this problem, but let us consider it a work in progress. I accept entirely that there are still problems, but I am glad that the World Health Organisation is now implementing what it calls an observatory on research and development, and that a working group will be set up to drive the matter forward.
The issue of condoms was raised by the hon. Lady and by the hon. Member for Strangford (Jim Shannon). I am very much in favour of the distribution of high-quality male and female condoms. What is more, I want to see much wider distribution of the benefits of microbicides, which were raised by the hon. Member for Glasgow North with respect to the rings and gels that are being used and in which we have invested some £20 million. I believe that that is essential.
The hon. Member for Strangford raised a key point—I think his words were that AIDS is being used as “a weapon of war.” He is right about that, and I want to see reproductive and sexual health as a key part of our response to any humanitarian emergency.
Of course, I want to see a successful replenishment of the Global Fund. That is essential—[Interruption.] The hon. Member for Glasgow North is signalling that he wants a commitment to be made now, but I am going to have to disappoint hon. Members over a figure and commitment now. That has to be left to the Secretary of State and it can only be done once the bilateral aid review and the multilateral aid review have been published. However, I am impressed by the way in which the Global Fund has attempted to address our preoccupation with women and girls and to make its response to women and girls central to its strategy. We now want to see how that changes things on the ground, because women’s needs are highly complex and our response has to be correspondingly comprehensive.
My hon. Friend the Member for Finchley and Golders Green asked me on a number of occasions how we were going to address the needs of women and girls, and it is a response that goes well beyond what we can do specifically to address the issue of AIDS. It is a question of changing culture and of changing law. It is a question of changing the perception of human rights. It is a question of changing economic development and of giving women the power to protect themselves. It is about empowering women and giving them information and access to family planning services. It is about giving them an education and a livelihood. All these things will empower women to ensure that they are enabled to negotiate the terms under which sexual intercourse takes place. However, I tell my hon. Friend this: a world free of AIDS—one in which absolutely no one is left behind—is one in which the rights of a girl are promoted and protected from the minute she is born.
We have had a very good debate. I reiterate the point that if the Department’s commitment to women and girls is comprehensive, it has to include and specify dealing with HIV and AIDS. I thank colleagues and the Minister for taking part today.
Question put and agreed to.
That this House has considered tackling HIV in women and girls.
Worcester University Arena: Disabled People and Sport
[Mr Philip Hollobone in the Chair]
I beg to move,
That this House has considered Worcester University Arena: supporting disabled people into work through sport.
It is a great pleasure, Mr Hollobone, to hold this debate under your chairmanship on my birthday and in the week after Worcester’s first successful Disability Confident jobs event in our magnificent Guildhall. I thank the University of Worcester and Leonard Cheshire Disability for the valuable briefings they provided ahead of today’s debate. In particular, I pay tribute to the people of Worcester with the vison to create a leading centre for disability sport in the heart of my constituency. I am delighted to do so with a Minister who, as a local lad, not only knows Worcestershire well but is a dedicated sports fan and passionate about improving the life chances and opportunities for work for disabled people.
My hon. Friend knows well how impressive the facilities at Worcester University Arena already are because he visited them with me last year and was able to meet some of the phenomenal and inspiring athletes who use them. He will recall meeting Sophie Carigill, captain of the GB women’s wheelchair basketball team, David Green, the Vice Chancellor, and Mick Donovan, head of sport at the university, who launched his vision for an international centre for inclusive sport there.
The Minister needs no explanation that the Worcester University Arena was the first purpose-built wholly accessible basketball venue where not only the viewing facilities and playing facilities but the changing rooms, accommodation and media facilities are entirely accessible to wheelchair users. He does not need to be told about the transformational part this can play for wheelchair athletes because he has seen it and heard about it himself. With him, I heard Sophie give the moving and important feedback that coming to play in the arena was the first time she had felt normal since her tragic car accident, and that she was not being specially catered for. She just felt that the venue allowed her to perform on an equal footing. With the Minister, I met other athletes with disabilities ranging from sight loss through to deafness and learning difficulties, who were inspired by the idea of a new international centre for accessible sport at the university.
Newly acquired land to the west of Worcester and around the existing arena for expansion, and plans to extend its reach further into blind cricket, football and tennis, as well as more wheelchair sports, has the potential to transform not only Worcester’s facilities for accessible sport, but those of the UK. Such a centre can play a crucial role in supporting more disabled people to achieve their ambitions, including accessing work. I want to set out today some of the evidence for that, some of the reasoning behind it and some of the reasons why I believe this venture deserves the Government’s support.
We know that too few disabled people have access to sport and I am glad that the new sports strategy set out by our hon. Friend the Sports Minister has made increasing disabled participation and the experience of watching sport key priorities, as well as increasing diversity in sports leadership and administration. Research from Leonard Cheshire Disability ahead of the Paralympic games highlighted the necessity of this and found that over half—57%—of disabled people surveyed said they had completed no moderate-intensity physical activity in the previous seven days, compared with just 24% of non-disabled adults. Of those surveyed, 41% identified lack of suitable activities and exercise provision as the main barrier, with inaccessible facilities and fear of injury also being identified as significant barriers.
Leonard Cheshire Disability said that the employment rate for disabled people is currently around 46.7% compared with a record rate of around 80% in the rest of the population. In Worcester, the employment rate is even higher, but a recent report from the city council’s scrutiny committee, which I support, has pointed out that it is still a concern that disability unemployment remains stubbornly high. The disability employment gap nationally stands at around 33% and, like Leonard Cheshire Disability, I warmly welcome the Government’s worthwhile and progressive goal of halving that gap. That is the right thing to do not just for disabled people but for the whole economy.
Social Market Foundation research suggests that if the disability gap was halved and those who fell out of work as a result of disability were reinstated, we could see another 600,000 people in work and the economy would be boosted by an estimated £13 billion. I welcome the progress that has been made with 293,000 more disabled people working over the last two years, but I share the Minister’s conviction that there is much further to go.
The Minister and I spoke about these issues at the last Conservative party conference and competed with each other in our enthusiasm for the employment goal, but I admit that I have learned a great deal from him in his determination to achieve it. I have shamelessly plagiarised his approach to reverse jobs fairs under the Disability Confident banner and it is greatly to his credit that the event in Worcester last week has been widely heralded as a success. It was supported by a number of local businesses, including Sanctuary Housing, Malvern Instruments, Dolphin Computer Access, Wits End Wizardry and Waitrose, whose first store in Worcester is due to open in June. It was attended by a wide range of local disability charities, including the wonderful Headway, Sight Concern, ASPIE, the Aspire Academy and the Royal British Legion, as well as the Access to Work and Disability Confident teams at the Department for Work and Pensions. I thank all those who took part, especially local businesses, the Chamber of Commerce and the Worcestershire local enterprise partnership who came along and made pledges.
The most impressive team at the Disability Confident event was the team from the University of Worcester, comprising two wheelchair athletes, Alex Giles and Tom Horrocks, and the England and GB blind football star and University of Worcester communications manager, Will Norman. Each of these athletes spoke about the vital importance of the facilities the arena provides, the huge potential of its future development and the employability benefits, such as communication skills and teamwork, that accessible sport has given them.
Will Norman is not only a brilliant role model in his sporting achievements, but a wonderful ambassador for the university and its wider support for job opportunities for people with disabilities. He is a highly successful communications professional, as well as a national athlete and footballer, who has written passionately about the benefits of supporting disability sport and real inclusion that treats those with disabilities not as other, but as part of the whole.
We were joined at the event by a former student of the university whose testimony is worth bearing in mind because it exemplifies both the challenges that disabled people may face and the huge success they can achieve when those challenges are overcome. Jordan Powell, aged 24, a graduate in history and politics at the University of Worcester, said he spent two years not even getting interviews for hundreds of jobs until he deliberately neglected to tell recruiters he was disabled. Within one week of not declaring it on job forms he was offered interviews at four different companies, and now works in telesales for London estate agent, Ludlowthompson. He said:
“In two years I applied for jobs every day, I went for hundreds of them and couldn’t get anything,”
“So I decided not to tell people and within a week I’d got four interviews—I’m now a telesales executive and I’ve smashed sales records for my company.”
Jordan came to see me some months ago in my surgery in Worcester to share his story and his concerns about the prejudice and fear that too many employers still feel towards disabled people. He explained that he felt that much of the prejudice was based on unfounded fears that they would not be able to support someone with a disability, and said that he wanted to help address those fears. He told me how Ludlowthompson had gone out of its way to make him welcome and even offered to tear its offices apart if it would help him, but that other companies had invited him to interviews that were upstairs and then failed to make allowances or adjustments when he turned up in a wheelchair. Within months of getting the job with Ludlowthomson in Worcester, he was setting new records for the company, and he told me that it was having to rewrite its remuneration policy to take account of the level of sales he has recently been achieving.
I was delighted when Jordan, who has also run as a council candidate for the Labour party in Worcester, agreed to work with me on a cross-party basis to deliver the recent Disability Confident event. His testimony was a powerful addition to it. The head of human resources at Sanctuary Housing, the largest residential social landlord in the country, said she had been convinced by his testimony and that he has changed some of Sanctuary’s policies and made it a more disability-confident employer.
Jordan also told me how playing accessible football at the university helped to build his confidence and enabled him to recognise that being in a wheelchair need be no impediment to achievement. Jordan’s story is by no means unique. The facilities that the university arena offers have already impacted thousands of people both with and without disabilities. In its first 12 months of operation it welcomed over 500,000 people, including 150,000 children, and staged 70 major national and international sporting events, 40% of which had a disability focus.
A direct impact of inclusion by design has been that Worcester has welcomed thousands of disabled and non-disabled athletes. Activities range from beginner classes for youngsters who have never engaged in sport to international junior wheelchair basketball championships. Student coaches currently deliver outreach wheelchair sports and inclusive sports sessions in more than 50 partner schools in the region and present inclusive coach education programmes and workshops in the arena to more than 60 disability organisations each year.
The economic impact of the arena for the local community has been estimated as at least £9.4 million.
The university’s unique disability sport coaching degree is developing the next generation of inclusive coaches who have an impact on hundreds of local schoolchildren who will go on to have an impact at local, national and international level. Significantly, more than 300 students on other degree courses at the university have selected specialist modules on inclusion and disability sport coaching. One of the most impressive things to see on a visit to the arena is not only the many students with and without disabilities training to teach disability sports, but the number of disabled athletes and students training to coach sports in mainstream settings. What a wonderful example it would set to have in mainstream schools more sports and PE teachers who themselves have overcome the challenge of a disability and can demonstrate to students of all abilities their passion for and achievement in sport.
It is no wonder that Sir Philip Craven MBE, president of the International Paralympic Committee, who officially opened the venue, said:
“I’m blown away by the University Arena. It goes to show what can happen when you have the right people with the right attitudes—they’ve created a wonderful place. This facility has clearly come from a passion for sport—a passion for everybody being involved in sport.”
The arena now forms the heartbeat of the university’s recently launched international centre for inclusive sport, which has attracted partners from around the world in all forms of sport, including universities in Europe, the US and China and international disability sport governing bodies from around the world, which will be invited to conferences and workshops to share good practice for the benefit of youngsters on their programmes.
The European wheelchair basketball championships of 2015 attracted 400 athletes and officials and were viewed in person or online by more than 200,000 spectators. That was the single most successful inclusive Paralympic sporting event since the London 2012 Paralympics, which did so much to inspire a generation about the potential of disabled athletes and increase the media following of accessible sport.
Subsequently, there has been a surge in interest from universities and sporting clubs wishing to visit Worcester and look at ways of replicating the design and inclusive agenda of our arena. For Worcester as a city, the spectacle of hundreds of athletes in national team colours arriving in their wheelchairs has already done wonders for local people’s appreciation of disability confidence and disability sport in general. I am delighted that the city continues to build on that legacy and that later this year the Worcester Warriors, my local rugby team, will host the county’s first international mixed ability rugby tournament, in conjunction with charities including Combat Stress. I am proud that our local premiership rugby team are the first in that league to be supporting mixed ability sport.
The arena has also delivered direct benefits in terms of employment for people with and without disabilities. In recent years, thousands of University of Worcester students have actively engaged in work placements with a focus on disability sport. It is significant that a vast number of graduates have secured posts throughout the UK that specialise in disability and disability sport-related activities. Many of them have disabilities themselves. Just a short round-up of recent examples would include a wheelchair user in a sports media post, a visually impaired student who is now in a media post, wheelchair users and power wheelchair users who have secured coaching roles, a double amputee who is a sports development officer in the south of England, a deaf student who is now a teacher in a special school for pupils with behavioural problems, a blind footballer working for a leading telecommunications company, a power wheelchair user who is now a community power wheelchair coach, a wheelchair user doing performance analysis for the GB wheelchair basketball team, a blind student who is now working for a national company as a provider of disability equality training and another blind student who is now working for a national foundation supporting disabled and disadvantaged people.
Many current University of Worcester disabled students are also employed as ambassadors for the university in outreach work throughout the UK to inspire others. The list of non-disabled students who have entered careers as strategic leaders, coaches, teachers or support workers for those with disabilities is too extensive to include in this speech. Beyond that are hundreds more—
I thank the hon. Gentleman for bringing this extremely important debate to Westminster Hall. I am heartened by the work that he is describing. Will he do the all-party parliamentary group on disability the honour of linking us to the university arena and also coming to speak in that forum in order that we can look at continuing that work elsewhere?
I would be delighted to do that and I thank the hon. Lady for her intervention. I would also be delighted to extend an invitation to the all-party group to come and visit the Worcester arena, because I think it is a genuinely unique national asset and something that we should draw to the attention of that group, so I am very grateful for the intervention.
Beyond that are hundreds more people who will be inspired to believe in themselves and develop their skills at both competitive and participatory level by the arena and the access to sport that it provides. Crucially, it is not just a venue for international level or even university level sport, but a key facility for encouraging and supporting basic participation and inclusion for groups ranging from schools to hospices to the elderly. Charities such as Whizz-Kidz nationally and Acorns Children’s Hospice locally have already benefited from its facilities, and I expect many more to do so as the international centre for inclusive sport widens its scope and reach.
The arena received some of its initial funding from the national lottery’s Iconic Facilities Fund and later received the Guardian award for a building that inspires. I suggest that its contribution, both present and future, to disability confidence and disability employment is one more reason why it should continue to inspire and be an icon.
I know that the Minister shares my enthusiasm for this inspirational Worcester landmark. I urge him to ensure that colleagues across Government share the knowledge of what it does and can do for disabled people. I ask for his continuing support as we seek to create in Worcester a genuine gold standard for disability confidence, with a gold-clad heart in our international centre for inclusive sport. I hope that he will continue to work with me to ensure that Worcester can become a beacon for disability confidence and to improve the lives, the life chances and the working opportunities for disabled people.
I am sure that there will be general rejoicing on the streets of Worcester today, but let me add my congratulations to my hon. Friend on the occasion of his birthday.
It is always a pleasure to serve under your chairmanship, Mr Hollobone. I, too, wish my hon. Friend the Member for Worcester (Mr Walker) a very happy birthday. He highlighted the fact that I was a local Worcestershire lad. I remember, on my 18th birthday, on that Saturday afternoon, purchasing a record from Pure Records—happy memories.
I pay tribute to my hon. Friend, who is a real local champion. The majority of my response will be on sport, but first I want to comment on his hosting of the Disability Confident event and the success of his own reverse jobs fair in engaging with the local business community to create crucial opportunities for disabled people to get into work, as part of our commitment to halve the disability employment gap. All too often, businesses lack the confidence to make what are often very small changes. In introducing such employers to the vast wealth of support groups, charities and organisations that will help disabled people to find work, my hon. Friend can be very proud of what a great success he made of that event. There are people who will now get an opportunity that, had he not made that effort, they would never have had.
I am delighted to talk about sport. Clearly, it is crucial to healthy, active lifestyles—disabled people are twice as likely to be inactive as non-disabled people. Sport can directly create job opportunities, as has been highlighted throughout this debate, and we also saw, in the case of Jordan Powell, how it helped to build his confidence to go on to find work. Sport creates role models to inspire people, in particular young people, and also, all too often forgotten, there is the actual enjoyment in sport. Certainly my visit to Worcester arena was really enjoyable. There were inspirational people delivering transformational opportunities. There is a track record of success where it has genuinely made a difference. The irony was that before I arrived to see all those healthy, active people, I had a McDonald’s breakfast, as I had arrived early, so there is still some way to go for me.
The facilities at Worcester arena are fantastic. It caters for disability by design—it is not an exception, but a given. The arena was specifically designed to be accessible to all. This is not just about the physical structure; it is also about the need to allow assistance dogs—they are welcome throughout. There is an induction loop system throughout the building. There is also the extensive training for staff and the awareness. It is just a case of disability being a given, not the exception. The people who designed the arena did not just think about the obvious, such as where the sport would take place. This goes right across the board. It includes the changing rooms and the accommodation. The student halls were built at the same time, and people were working on the assumption that outside term time, when the competition events took place, they would become accommodation for the athletes. As a given, they were 100% fully accessible, as were the media facilities. Therefore, unsurprisingly, the facility was busy. That seems like a silly, obvious thing to say, but actually too often we go to iconic buildings and they are amazing but hardly anybody is using them. That is not the case with the arena, which is permanently in use and therefore able to attract major sporting events, which is brilliant for creating role models. That was not an accident; inspirational people realised that they had to work in partnership.
The arena was created in conjunction with organisations such as Sport England, through its Iconic Facilities Olympic Legacy Fund—a catchy title—as well as with the Foundation for Sport and the Arts, Basketball England, Badminton England, many other sporting groups, the local authority, local businesses and the local community. It is not just the students who benefit, although it is great that they do; people come from far and wide to benefit from the fantastic facilities. By listening to and engaging with them at the concept, we got a facility that would always be a success.
Underlying all that was the aim to ensure that the facility was commercially viable. Too often, a ribbon is cut and the great and the good turn up to celebrate the opening. Without a good business plan behind that, there would be savings on the maintenance, opening times, programmes and activities. Right from the beginning, it was understood that the facility should never lie dormant for long periods of time and should maximise commercial opportunities—students, local sports clubs and the community, as well as the elite and professional athletes.
I was interested to see that Worcestershire County Cricket Club, Worcester Wolves, Aston Villa Football Club, Birmingham City Football Club, West Bromwich Albion Football Club and many other groups were taking part. Those are household names and they provided support, including enjoyment, performance analysis—that would have been a pretty painful thing for me during my sporting career—and fitness and nutrition advice. That was my McDonald’s breakfast; they knew I was coming. The arena has become the home ground for sporting clubs such as the Worcester Wolves basketball team and the GB men’s wheelchair basketball team. That is a fantastic legacy.
It does not stop there. The ambition is to continue to expand to create further partnerships. Worcestershire County Cricket Club is looking to do a lot more with its Chance to Shine programme and new inclusive cricket centre. As a cricket fan, I would be delighted to make a return visit. The arena really has helped with Sport England’s narrative of saying that where it is providing funding, major capital investments are required to make its facilities accessible.
Sport England goes further by publishing free online tools and guidance to support designers, building owners and operators to create accessible facilities. Having such a success story makes it an easier sell, as it can say, “Look, this isn’t an inconvenience for you. By making those changes at the beginning, you will benefit commercially and with usage. This is a win-win for everybody.”
We want to ensure that not just the people who go along to Worcester Arena benefit but that, right across the board, accessible sporting opportunities are a given. Part of that is ensuring that the topic is part of the education of the next generation of PE teachers. The University of Worcester has led on that, because it is a given that it is part of its education process. It is integral, as it is part of modules.
I know how important educating PE teachers on the subject is because, randomly, I was selected to open a PE conference on behalf of the Government—I think somebody misread somebody else’s biog and attached it to me, so I had to do a keynote speech on the topic. I had to be very creative that morning. One thing that came back to me was the number of PE teachers who wanted to offer more accessible sporting opportunities but feared that perhaps they would get it wrong, end up doing something where they might be sued, that there would be an accident or that things would not go right. As a given, the next generation will have that confidence. I give credit to the English Federation of Disability Sport and to Sainsbury’s for their successful course to upskill existing PE teachers to ensure that PE staff have that confidence. I pay tribute to the PE teachers I met, and there were hundreds. There is a genuine appetite to do this.
I do millions of visits. One of the most fun visits I ever did was to see the Swindon Vixens disability netball team—young adults who had never ever had an opportunity to enjoy sport. They were put through a weekly one-hour session with professional coach. The session was enjoyable but structured, and they were gaining genuinely good skills. The enjoyment levels of those young adults was such that I genuinely thought they might explode! The serious side of it was that one of the girls lost 3 stone in the first few months of doing netball because it was the first and only time that she had ever had a sporting opportunity.
The Minister’s information shows very clearly—I hope he would agree—that sport is not just about physical activity and physical health, but about mental wellbeing, mental health, self-esteem and self-confidence.
I could not agree more. I am delighted that the hon. Lady has extended an invitation to my hon. Friend the Member for Worcester to speak at her all-party parliamentary group. I spoke there previously and I know what an engaged group it is. That is a great opportunity to highlight the topic further.
The Government are bringing forward the sport strategy. Part of that will be how Sport England spends its £170 million to make sport a practical and attractive lifestyle choice for disabled people. That is vital because currently only 4% of elite coaches are disabled. Jordan Powell was a great example of how sport gives young people the skills and behaviours that are linked to school attainment and employment opportunities. Across sport, there is a lack of disabled employees, but there are lots of examples of how we are creating more opportunities.
Sports bodies and groups are currently not capitalising on the talent, skills and diversity of the entire population. I am forever highlighting the fact that one in six people in this country have a disability. Their combined spending power is £212 billion. It is called the purple pound. It is not Nigel Farage’s utopian dream; it is something that has been highlighted by sporting groups making those changes and I have heard, time and again, just how they have benefited from doing so.
We are not resting; we are not waiting for this all to happen by accident. I set up a round table, which included the Sport and Recreation Alliance, Sport England, the English Federation of Disability Sport, the Youth Sport Trust, the Amateur Swimming Association, the Tennis Foundation, the Royal Yachting Association, Boccia England, British Wheelchair Basketball and Disability Rights UK. The aim was to look at how we can further shape the sport strategy. I have regular meetings with many other sporting organisations, including the Premier League and the Football League, about making facilities more accessible for disabled supporters, as well as with the Rugby Football Union and the British Paralympic Association. Some fantastic work is going on and, at the heart of that, Worcester arena is held up as a shining, beaming example.
I pay tribute to Channel 4, because there are also employment opportunities in the media. It has been successful in securing the rights to cover the Rio Paralympics and made a genuine commitment that half its presenters for that event will be those with a disability. It is not just doing that to tick a box—that would do a disservice to potential disabled presenters. The channel wants people who have a talent to take advantage of the opportunity to further their careers and to have further opportunities, whether with Channel 4 or other media organisations. It has gone right back to the training colleges and the performing arts people, saying, “Look, we wish to recruit. You find people who have the enthusiasm and the talent. You train them.” There are genuine job opportunities coming from there, which is a real credit to those organisations.
I went on a brilliant visit, championed by a fantastic constituency MP who is held in such high regard. I saw that as we visited all those people. There were so many inspirational people who have made Worcester arena such a success. I am excited that it does not stop there and that there will be further opportunities. My hon. Friend made it very clear that he felt that Worcester arena was gold standard. I think it is platinum standard. In material terms, that is even higher rated.
I hope that many other organisations can look and learn, and create the same sorts of enjoyment and opportunities that Worcester Arena does. It is a real tribute to my hon. Friend that he has highlighted that today. He will have a further opportunity to showcase all the fantastic work that is going on right at the heart of his community with the all-party parliamentary group. Once again—what a way to celebrate my hon. Friend’s birthday.
Question put and agreed to.
I beg to move,
That this House has considered the future funding of supported housing.
It is a pleasure to serve under your chairmanship, Mr Hollobone. The House was told by the new Secretary of State for Work and Pensions on 21 March 2016 that the Government
“have no further plans to make welfare savings beyond the very substantial savings legislated for by Parliament two weeks ago, which we will now focus on implementing.”—[Official Report, 21 March 2016; Vol. 607, c. 1268.]
That assurance to the whole House was repeated the following day by the Chancellor of the Exchequer.
The purpose of this debate is to remind the Government of the consequences of imposing the local housing allowance on supported housing. The proposals will definitely be a further cut in welfare provision. The local housing allowance was introduced in order to cap the housing benefit given to private landlords. The cap is locally set, and it limits the amount of housing benefit to a figure based on the lowest 30% of the rental market in each local authority. In Newcastle upon Tyne, the city that I have the honour and privilege of representing in this place, it would mean a cap of £90 a week on housing benefit for a one-bedroom flat or £60 a week for a room in shared accommodation—£60 a week is the benefit offered to anyone under 35 years old who is single and has no dependants. It is a quirk of the system that supported housing in more prosperous boroughs is less badly hit by the measure because private sector rental levels, on which the calculation is based, are higher.
My right hon. Friend mentions prosperous boroughs, and the London Borough of Ealing would, on paper, count as one of them. Does he agree that it is a scandal that, even in my constituency, groups such as YMCA West London are being hit? One of my very early engagements as an MP was with my hon. Friend the Member for Ealing North (Stephen Pound). We went to look at YMCA West London’s refurbished hostel in south Ealing. After the summer Budget and the 1% cut in social rents, YMCA West London wrote to me and said that, because it had used all its cash reserves to refurbish the hostel on a business plan that assumed future rental levels, it was looking at staff cuts, service reductions or possible closure. Is that not a scandal?
I agree wholeheartedly with my hon. Friend. Perhaps I should have said “relatively prosperous.” The distinction will be clear to people in the north-east of England, but perhaps less so to her constituents. She raises another important point, which is the uncertainty hanging over the arrangements, and I will have more to say about that later.
Returning to the Government’s intention, the changes introduced in the autumn statement extended the cap into the social sector, in line with the provisions that already pertained in the private rented sector, which means that the rate paid to private renters on housing benefit will apply to the social sector, too. The measure will apply to new tenancy agreements signed after 1 April 2016, with the rate changing on 1 April 2018.
The right hon. Gentleman will know that, during the Report stage of the Welfare Reform and Work Act 2016, Members on both sides of the House encouraged Ministers to introduce the moratorium—the 12-month review—on these specific housing developments, which gives us, on a bipartisan basis, an opportunity to consider the work being undertaken by specialist housing providers and to try to find consensus to offset what were originally envisaged to be quite draconian changes.
I would like to find a consensual way through this, but maybe the Government should have thought about these matters before applying the measure to social housing. If they propose reform, they should think about what the reform should be and then introduce it, rather than introducing it in such a heavy-handed way and then saying, “Maybe we’ve gone too far. We had better have a review.” Like the hon. Gentleman, I would be fascinated to know what the review has come up with, because it is due about now. In fact, I think the Minister said it was due in March 2016.
My right hon. Friend is being generous with his time. Does he agree that the Government should have given due consideration to those people who suffer from mental illness and who will be affected by these “draconian” cuts, as the hon. Member for Peterborough (Mr Jackson) put it, to their housing benefit?
I certainly agree, and I intend to go through a range of people who are affected by the measure. When I was researching for this debate, I found that the list was far more extensive than I originally thought. The measure is projected to save the Exchequer £120 million in 2018-19, rising to £225 million by 2020-21. The Government have said that they will delay the imposition of the cap on supported housing for one year, and they are currently reviewing the application of the cut to such housing. They have said that the review will
“provide a foundation to support further decisions on protections for the supported housing sector in the long term.”
Perhaps the Minister will explain what that means and tell us when the review will report, because we are all interested.
The uncertainty is damaging enough. Supported housing is a type of social housing that includes a care element. It allows those who cannot live by themselves without care to live independently with a support worker and with dignity in a place to call their own. Due to the very nature of supported housing—including a care element—it is more expensive, and thus a cap limiting weekly rent to as little as £60 will mean that much of it is unaffordable. In essence, the most vulnerable, those who need care in order to live, will have their housing benefit cut. Supported housing for vulnerable adults and young people who need help to live independently can include housing for people with learning difficulties, social problems or mental health issues; vulnerable older people; women fleeing violence; people with physical disabilities; and servicemen and women. Surely if anyone is especially entitled to our consideration, support and affection, it must be those groups, and particularly ex-service personnel.
The Byker Community Trust in my constituency runs supported housing for veterans of the armed forces. The trust has low rents because it is a relatively young stock transfer organisation. Comparatively, it is one of the cheapest in Newcastle upon Tyne. However, the rents for veterans will significantly exceed the local housing allowance cap. Veterans in supported housing in the Byker Community Trust will have a shortfall of £32.50 a week if they are over 35 years old. If they are under 35 years old, they will need to find an extra £63.48 a week to cover the cost. The Army values the provision, and indeed it has supported its introduction. One veteran told me that
“the army does everything for you when you are service personnel, adjusting to civilian life was difficult.”
He did not know what he would do without the project.
Supported housing includes housing for young single people who are at risk of sleeping rough, begging in the streets and spending what little money they have on legal highs. Uncared for, they need the constructive intervention of adults. Supported housing is an appropriate and proportionate way of responding to those problems, which are covered by a range of Government agencies.
Tyne Housing in my constituency has a site in Newcastle East at St Silas’s church. It provides supported housing and day services for vulnerable and isolated people. The housing is provided mainly through single-person flats and supportive workshops to help people lead a full and fulfilling life. That specialist housing project is exactly the type of provision that will be hit by the cap. The project’s leaders tell me that as a result of the Government’s changes, the project will have to close; it is as straightforward as that. Those affected are vulnerable and need our help, but if the Government proceed with the cap as proposed, they will fail those people. The local cap on funding for supported housing could have huge repercussions. The National Housing Federation has released figures estimating that 82,000 specialist homes will be threatened with closure, just under half of all supported housing in England. That will leave an estimated 50,000 vulnerable tenants who are unable to work without support.
The uncertainty is having an immediate impact. Services coming up for re-tender are at risk of closure, irrespective of the outcome of the review, simply because the providers cannot make a potentially unfunded commitment in respect of what might happen beyond 2018. The National Housing Federation has said that 2,400 planned new homes have already been scrapped as a result of the cap, and almost a quarter of supported housing providers, 24%, told the NHF that all their supported and sheltered units are at risk of becoming unviable and closing if the cap is implemented.
The cut will cause serious problems for providers in Newcastle and the north-east. Changing Lives Housing Trust is a national registered charity based in Newcastle that provides specialist support services throughout England to thousands of vulnerable people and their families. It provides support to homeless people, recovering addicts and ex-offenders, as well as providing specialist women’s and family services. The charity has estimated that the cap will lead to an annual shortfall of £2 million in funding for its services.
Isos Housing, which manages more than 17,000 homes across the north-east, calculates that 700 of its 900 supported housing tenants will be affected by the cut, losing an average of £80 a week. Home Group, another major provider in the north-east, estimates that 223 services covering some 3,945 beds will become unviable if the proposals are implemented.
The Government seem to be aware of the problem, hence the review, but I hope that this debate will prove a useful chance and platform for the Minister to tell us where the policy is going. The Government policy, as announced, will have a number of unintended consequences. The most obvious question is where will those vulnerable people go when supported housing is no longer affordable? What alternatives do they face? The likelihood of suffering and exploitation is obvious. The immediate concern is a rise in homelessness and its consequences. Some people may end up with the police or in national health service emergency provision, such as accident and emergency; others may find themselves exploited without housing support or accommodated in unsuitable housing.
Home Group’s average accommodation costs for someone with learning disabilities are £13,500 per bed space per year, or £260 a week. In its challenging behaviour and learning disabilities costing statement the National Institute for Health and Care Excellence estimates that NHS inpatient care for people with learning disabilities costs between £96,000 and £197,000 per person per year. The average hospital day bed costs about £300. By comparison, a night in a prison cell costs £418, and an ambulance call-out averages about £250. The difference in cost between supported housing and NHS care is huge. Ultimately, the taxpayer is better off with supported housing.
Home Group estimates from the Department of Work and Pensions’ own figures that the cost implications of losing supported housing could be as much as £2.5 billion. I ask the House to consider that—a cost of £2.5 billion in unintended consequences, spread across different Departments but falling pretty heavily on the Department of Health, for an attempted saving of £225 million. We ought to pause and rethink. Supported housing is money well spent and proportionate to the range of problems that it addresses. It is a relatively small expense that, if cut, could cause great misery to the most vulnerable and great cost to the taxpayer. The answer is to exempt supported housing from the proposed cuts.
I have two extra points to raise with the Minister. The Government should say what their proposals are for the future of supported housing under universal credit. I hope that the answer is something better than, “We are giving local authorities a small grant to try to do what they can for themselves, but they’ll have the power to do it themselves”—not the money, of course; just the responsibility. I hope that he can say something more comforting than that. Perhaps he will be able to tell us what funding structures will exist to fund supported housing when housing benefit is abolished under the universal credit structures proposed for 2018. Can he update us on that?
If the Minister cannot give us the full policy, can he at least update us on the findings from the review, which we are all expecting and which he promised in March? The promise has now mulched into “in the spring”, but in any event the review is imminent. Perhaps now would be a good time for him to tell us how he intends to avoid the hardship that I have outlined, and how he feels he can best give assurance to an important sector desperately in need of it.
This debate is to finish at 5.30, and it is clearly well supported. The recommended time limits for Front-Bench speeches are five minutes for the Scottish National party, five minutes for the Labour party and 10 minutes for the Minister, and then Mr Nicholas Brown will have a couple of minutes at the end to sum up. Eight people are standing, and there are 18 minutes until I call the SNP Front-Bench spokesman, so I am afraid you must limit yourselves to two and a half minutes each so that everyone can get in. If people intervene on speeches, I will not be able to accommodate everybody. I will impose a time limit of two and a half minutes. I know it is not very long, but I hope everyone can get in.
I will do my best, Mr Hollobone. I am grateful to the right hon. Member for Newcastle upon Tyne East (Mr Brown) for securing this debate, which comes at an opportune time, given that the Government’s review is taking place. I urge the Government, in carrying out the review, to start with a clean piece of paper. As we heard from the right hon. Gentleman, a lot of vulnerable people will be affected by the changes. I will not go through them in detail, but the feedback that I am receiving in Suffolk is that the recent changes to and restrictions on rental income for social housing providers and the changes in capital funding for adult social care are having a direct negative effect on capital investment available for supported housing schemes, leading to fewer and less innovative projects.
In moving forward with the review, my plea to the Government would be to break out of departmental silos. This is not just an issue for the Department for Communities and Local Government and the Department for Work and Pensions; it is not just about housing and benefits. It is an issue for the Department of Health, as it concerns physical and mental healthcare, and it is a job for the Department for Business, Innovation and Skills, as it concerns preparing vulnerable people for the workplace.
It is also necessary to involve councils, which deliver these policies at the coalface, whether as housing authorities or social care providers. It is important to listen to housing associations and charities that are carrying out innovative projects that change people’s lives and that in the long term are sustainable financially. These include Give Us A Chance and the Papworth Trust, and—more locally in Suffolk—Saffron Housing Trust, Orwell Housing Association, Stonham Housing Association, and Access Community Trust, which has done great work in Lowestoft for many years.
As supported housing involves more than just housing and has wider benefits outside the walls of DWP and DCLG, we need to consider a wider range of funding sources from other Departments. Perhaps devolution provides a means of securing these funds. Also, councils should be encouraged to pursue an open-book approach to negotiations rather than fixed-price tendering. That way, tailored, bespoke and long-term solutions can be provided to meet specific local challenges and needs. In summary, let us start with a clean piece of paper, work collaboratively and think long-term.
Welcome as the delay in introducing the housing benefit cuts for those in supported accommodation is, it is simply not enough merely to delay them. In my opinion, the UK Government must exempt supported housing tenants altogether from these devastating changes or find an alternative funding model. That is because change to housing benefit can undermine the ability of such tenants to pay their rent, thereby putting their home at risk and threatening both their physical and mental wellbeing, as well as posing a genuine threat to the financial sustainability of housing associations.
Such changes could have a devastating impact on the future provision of refuge accommodation in Scotland, where all refuge accommodation is in the ownership of either housing associations or local authorities. The Scottish Federation of Housing Associations has identified that associations in Scotland could lose between £5 million and £14 million per year, which would be completely unsustainable.
From within the industry, we have already had a range of apocalyptic warnings from informed and knowledgeable service providers. A survey conducted by Scottish Women's Aid found that,
“in a rural area, introducing a cap linked to the LHA rate”—
that is, the local housing allowance rate—
“would result in an annual loss of £5,800 for a 2 bedroom refuge flat. In an urban area, the annual loss for a 1 bedroom refuge flat would be £7,100, and in another semi-urban area the loss on a 3 bedroom refuge would be £11,600 per year.”
David Orr, the chief executive of the National Housing Federation, said in December:
“The impact of the LHA cap on the amount of Housing Benefit payable for supported housing will be stark and make it extremely difficult for any housing associations to develop new supported housing. Without existing levels of benefit being available, providers across the country will be forced to close schemes.”
That is echoed by Andrew Redfern, chief executive of Framework, a specialist housing association, who has said:
“It would mean the end of supported housing. All our schemes would close, and I think all others would as well.”
Also, an Inside Housing article from 21 January laid bare the impact of capping housing benefit, identifying that only 5% of schemes could survive, which is a shocking figure.
In conclusion, the LHA bears no resemblance to the actual costs incurred by supported accommodation providers and if, as a result, such housing options became financially unviable, vulnerable tenants might be forced into potentially costlier alternatives, such as institutional care, funding increased hospital stays, the higher cost of private landlord housing and—in the worst case—the higher costs of imprisonment. This move must surely be the very definition of fiscal irresponsibility.
I am indebted to the right hon. Member for Newcastle upon Tyne East (Mr Brown) for bringing this debate to Westminster Hall.
I was first alerted to this issue not when I had the honour to serve on the Housing and Planning Bill Committee but via one of my local housing associations. Alan Lewin, the chief executive of Axiom Housing Association, talked about the viability of supported housing schemes in low-cost areas and how the reduction in rent was very likely to reduce their viability permanently, not only in places such as Fenland and around Peterborough but throughout the country.
I will briefly make a plea to the Minister by reiterating the comments of my hon. Friend the Member for Waveney (Peter Aldous) that this is a cross-departmental issue and it goes to the heart of the Treasury. If the Treasury really wants to restrict and reduce housing benefit payments and the cost of acute district hospital care, it has to think long-term and holistically, and put in place legal and financial inducements to providers across the piece to provide extra care and supported housing. So it is not only the Department for Communities and Local Government and the Department for Work and Pensions that are involved, but the Treasury. As I say, we have to think holistically.
I will also make the plea that this is a regional issue. Sometimes with our housing policy, we have been inclined to be very London-centric. There is a regional issue here, in terms of the affordability not only of general needs housing but of specific supported housing.
The mark of a civilised society is how it treats people who are voiceless, who do not have representatives and who are vulnerable, and it is important that we bear that in mind. All Governments make mistakes and all Governments are subject to the law of unintended consequences; that is very important to consider.
In this moratorium review, we must also take it into account that the costs of support for the particular individuals who we are discussing today are significantly higher than the costs of general needs housing. That is also a very important point.
Let us take in all the evidence from across the country, and let us have a proper regional and holistic approach, which must include a cost-benefit analysis of the costs that fall on things such as the criminal justice system and the NHS. Let us have a proper review and let us try to work together across party divides, so that at the end of the review we can have a consensus on looking after the needs of the people who really need our help—the most vulnerable.
I thank my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) for securing this debate. I am only sorry that we do not have more time for it. Lots of Opposition Members, particularly Labour Members, feel very strongly about this situation and there are some very important issues involved.
I will also raise a local issue. I thank the North Star Housing Group and its chief executive, Angela Lockwood. That organisation provides specialist housing, including specialist supported housing, within my constituency and across the north-east region. I wanted to highlight a number of examples, but I also want to point out the nature of the problem.
A recent survey by Inside Housing revealed that 95% of supported housing providers have stated they would have to close at least some of their schemes, and a quarter of those providers said they would have to close all their supported housing. That is particularly worrying for County Durham. There are 6,450 supported and specialist units across the county that support a range of people. As my right hon. Friend has already outlined, these people are very vulnerable, including people with mental, physical and learning disabilities; the elderly; people recovering from substance abuse; people trying to rebuild their lives; and women fleeing domestic violence, for whom supported accommodation could save their lives.
The very short-term financial savings that the Government hope to achieve will quickly evaporate, because supported and specialist housing helps to reduce crime and eases pressure on already overstretched health and social care services. If the Minister thinks that this measure will save money, he needs to reflect on the findings of the Homes and Communities Agency, which found that investing in supported housing saves the taxpayer £640 million annually. As other Members have pointed out, if there was a little forethought and cross-departmental co-operation between various Departments, the value of supported housing could be better appreciated.
We will not address the housing crisis by penalising the vulnerable or by cutting funding for supported and specialist housing. The best way out of the crisis is to build more properties of all types and tenures, not just starter homes at costs that are out of reach for many people, and to exempt specialist supported housing from the terms of this cap.
It is a pleasure to serve under your chairmanship, Mr Hollobone, and I thank my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) for securing this debate.
I will briefly talk about a specific issue regarding York. We have got a double jeopardy, because the broad market rental area is not specific enough and covers a much broader area than York. Consequently, we are already at a disadvantage with regard to the value of the local housing allowance. These changes that we are discussing today will make things even harder for the housing associations in York. So I ask the Minister to look specifically at the issues regarding York and the impact that they will have.
I have met with York Housing Association to talk about the impact the changes will have, not just, as we have heard, on the social benefit that investment in supported housing brings but on the hard figures—the economics. York Housing Association has 364 tenants and a rental income of £2.7 million, but with the local housing allowance cap its income is estimated to drop to between £670,000 and £880,000. The association supports really successful projects, which are held in high regard across the nation. The Arc Light Centre and its homelessness project has a more than 70% success rate of people going on to live independent lives and not returning to the streets. With such excellence within the housing schemes we do not want the cut, which will put masses of pressure and costs on to things such as the emergency services and accident and emergency, and put people back on our streets, which is the last thing we want.
I have also visited Seventh Avenue, where we have a supported housing scheme for people with severe physical and learning difficulties. If the changes go ahead, the scheme will not be able to run. It will see an annual shortfall of £18,830, which will mean losing a support worker who is absolutely vital to providing its services for people who are incredibly vulnerable and need the support of the state for their survival, let alone for providing quality of life. I have to assure the Minister that the scheme provides excellent quality for the people who live there.
In my remaining seconds, I urge the Minister to look at the evidence and listen again to the housing associations. They are the experts in the field and we need evidence-based policy in taking the situation forward.
The reduction of social housing rents by 1% and the cap on housing benefit on social housing tenancies will have a profound impact on providers, reducing their revenue stream. The housing associations have stressed to the Government that the consequences of the changes could be dramatic. They are likely not only to be forced to shelve developments currently under way but to close existing schemes, at a time when the need for supported housing for the elderly is growing sharply. We are seeing a reduction in both the revenue of the housing associations that provide social housing and the funds being made available to the vulnerable people who need to live in supported housing. One has to ask whether the Government want the state to continue to provide support for social housing or not. Based on the proposals thus far, I suspect not.
Magenta Living, which operates in my constituency, has said that tenants on benefits will have to find an extra £25 per week out of their other benefits. In future, vulnerable prospective tenants and homeless singles are likely to be unable to afford social housing. Where does the Minister think those people should live? Magenta also points out that the problem is particularly difficult in the case of acute care, where there is a need for significant communal space for assisted bathing, treatment rooms and so forth. Magenta has told me that the Government are undermining their own drive to increase the volume and scope of older persons’ housing at a time when social care is at crisis point.
Specialist housing schemes are really important for the most vulnerable people in our society, and it is on that provision that we should judge the civilised nature of our society. I ask the Government to think again, to find their point of compassion and to show support for supported housing.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) on securing this important debate.
There is an enormous breadth of supported housing. In my constituency we have a brilliant foyer, which supports young people, sheltered accommodation for blind and partially sighted residents, care homes for people with physical disabilities and sensory impairment, homes for people with learning disabilities, refuges for victims of domestic abuse, accommodation that supports young and vulnerable new mothers and their babies, many sheltered schemes and care homes for older residents, and supported housing for people with mental health needs. I have visited many of those facilities and have never failed to be moved by the difference to individual lives that is made by providing appropriate care and compassionate support, enabling people who have a wide range of needs to live the best, most independent and most fulfilled lives possible and, in the case of refuges for victims and survivors of domestic abuse, enabling women and their children to move on and rebuild their lives in a safe place, away from the horrors they have escaped. Supported housing is a positive investment that saves the public sector money in the long term.
Yet the National Housing Federation estimates that across the country there is already a shortfall of more than 15,600 supported housing places. It is absolutely no exaggeration to say that the Government have entirely avoidably thrown the sector into turmoil by proposing to cap the local housing allowance and introducing an annual rent reduction of 1%.
Over the past two months, I have met with five housing associations that are active in my constituency and provide supported housing, and have been struck by how strong an impact the Government’s policies are having. All the associations said that they were planning to reduce their current provision, all of them had put new schemes on hold for the time being, and one of them was exiting supported housing provision altogether. Those are not isolated examples. As my right hon. Friend the Member for Newcastle upon Tyne East said, Inside Housing magazine recently reported that 95% of providers would be forced to wind up some schemes if the LHA cap were introduced. There is a particular risk to smaller providers, which often deliver the most specialist and innovative supported housing but are not able to cross-subsidise that with mainstream housing.
There is an urgent need for the Government to bring the uncertainty and turmoil to an end, confirm the removal of both the LHA cap and the reduction in rents for the supported housing sector, and work with the sector on a viable, sustainable plan to deliver the supported housing we need to meet the current shortfall and the future growth in demand. Supported housing is vital for equality, for quality of life and for the development of compassionate communities where everyone can live life to the full.
Much has been said about the importance of supported housing to our communities. St Mungo’s provides a number of supported housing schemes in Brent, especially for people with mental health and substance abuse difficulties. It also supplies supported housing for people who come out of prison and are in the in-between stage—the one-stop stage. Although I welcome the Government’s rethink, it is a shame that we have come to this point because many of those who were supplying supported housing services had already flagged up the issue. Undue stress has been put on the organisations, and worrying about whether they would be able to stay in their supported accommodation has done nothing to help people’s mental wellbeing. Gandhi once said that we would be judged by how we treat the weak and vulnerable in society.
If the LHA cap is applied to St Mungo’s tenants, it is estimated that the organisation will quickly face an annual shortfall across its supported housing services of about £8.8 million. It would not be able to sustain such a dramatic shortfall and, like many of the other organisations we have heard about today, it would cease to provide housing. The cap would be such short-termism—penny-wise, pound-foolish, as the saying goes. Therefore, although we welcome the Government’s decision to rethink, it is a shame that we have come to this point and I hope that the Minister will listen to what Members on both sides of the House have to say.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the right hon. Member for Newcastle upon Tyne East (Mr Brown) for introducing the debate, the importance of which is demonstrated, I think, by the attendance. It is unfortunate that Members’ speeches have been limited to two and a half minutes. There have been some excellent contributions—too many for me to list.
I start my comments by setting the wider context, using an holistic approach—a phrase that has been used. The Government’s entire housing strategy must be considered a mess, unless we assume that they want to dismantle the concept of social housing. The much trumpeted right-to-buy scheme and its extension to the properties of social landlords will reduce overall stock, and will be compounded by the forced council house sell-off to fund replacement housing. It is clear that the replacement houses will not be like for like, and they may be located in areas where there is less demand. All those factors combined will have an effect on housing associations’ finances. The ironic reality will be an increase in the overall housing benefit bill, as private rents increase and more properties end up on the buy-to-let market.
Another issue for the social rented sector is the 1% rent reduction, which, according to the Government’s figures, will take £10 billion out of the social housing market by 2021. That £10 billion loss will obviously reduce the chances of some supported accommodation being affordable within a wider model. It is incredible that the Government have proposed a cap on social sector housing benefit rates without thinking about the impact on supported accommodation. The measure is expected to save only half a billion pounds over this parliamentary term. When compared with the £8.5 billion cut in corporation tax and the £5.5 billion of capital gains and inheritance tax giveaways in the Budget, that half a billion pounds is a drop in the ocean. The Government have admitted that they do not have statistics on those who access supported housing and have belatedly agreed to an impact assessment, which shows real flaws in their sign-off process.
The one-year delay in implementation can only be cautiously welcomed, because such accommodation may still be at risk. To use the fall-back answer that discretionary housing payments can be used misses the point completely. It is the argument used in relation to the bedroom tax, and it is the argument that the Government lost in court. I repeat that the term “discretionary” means that the funding is uncertain. It is impossible to believe that DHP will plug all the gaps. My local authority has confirmed that the overall DHP budget will need to be increased, so there will not be any real savings if that is the way the Government go.
We have heard that lifeline services are at stake. Let us be clear about that. Supported housing can end years of hell for those suffering from domestic abuse. It can save lives, prevent rough sleeping, support people with mental health issues and allow older people to live independently in a safe environment. That in itself can lead to offset savings in the NHS or reduce the need for people to be in a more intense and expensive residential home. It can help prevent bed blocking in the NHS. The polar opposite of supported housing provision does not bear thinking about. We have heard that there could be increased health costs, increased crime and increased costs associated with imprisonment.
As a councillor, I was pleased to see the construction of a new development in Kilmarnock called Lily Hill Gardens. It provides supported accommodation for people with special needs, allowing independent living within the complex, subject to a 24-hour telecare package. That project was truly transformational for the tenants. I shudder to think what will happen if future projects cannot go ahead.
One of the caseworkers in my office previously worked for Women’s Aid. The circumstances in which some people live are frightening, and I pay tribute to the dedication of the support staff and acknowledge the risks that they face. How undervalued must they feel at this moment? Kilmarnock Women’s Aid was able to confirm that it provides information, support and temporary refuge accommodation to women, children and young people experiencing domestic abuse. The impact of benefit sanctions and reforms are already having a disproportionate effect on women and lone parents. Universal credit, which will be paid monthly to one householder, further increases the possibility of financial abuse.
If refuge services are not exempted from housing benefit, a vital lifeline for women and children who need to find safety from domestic abuse could be lost. We have heard about the financial impact estimated by Scottish Women’s Aid and the fact that the Inside Housing article estimates that 95% of services could be lost. The Government do not need an impact assessment. Those points prove that an extended exemption for supported accommodation is required.
It is a pleasure to have this debate under your chairmanship, Mr Hollobone. I thank my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) for securing this debate. There does seem to be cross-party support for and interest in this issue, because it affects every constituency. My right hon. Friend mentioned how it affects the north-east, as did my hon. Friend the Member for Easington (Grahame M. Morris). I was very interested in what the hon. Member for Peterborough (Mr Jackson) said about how different the situation is outside London. Local housing allowance in London is at a completely different level from what it is in some rural areas. That important point must not be forgotten.
Supported housing means that no one is left behind. It is what makes a civilised society. We have heard passionate speeches today about how in all areas, people will be affected in different ways. The majority of supported housing tenants depend on housing benefit to cover the cost of their housing. The proposed application of the local housing allowance rate in social housing would have a significant impact on the most vulnerable residents in all our communities. The decision is already having a devastating effect before it even comes into force: the building of thousands of vital supported homes has been delayed or scrapped altogether because of uncertainty over future funding.
The National Housing Federation estimates that 82,000 specialist homes will be forced to close. That is 41% of all specialist housing. Last Friday I visited Emmaus Greenwich along with my hon. Friend the Member for Greenwich and Woolwich (Matthew Pennycook). It does a fantastic job. It does not just house people; it rebuilds lives. The introduction of the local housing allowance cap would mean a reduction of 40% of its housing benefit income, leading to a local shortfall of an estimated £86,000 a year. Nationally, Emmaus would lose around £3 million a year.
We have heard many passionate speeches today, and I would like to set out some questions for the Minister. We have the Housing Minister in front of us, but I understand that the decision is pretty much led by the Treasury and the Department for Work and Pensions, so he may not be able to answer the questions today. If he cannot, I ask him to commit to writing with the answers. Will he commit to working with the sector to try to understand the impact of the decision? Has he had conversations about that? There is some uncertainty. It has been mooted that only new tenancies will be affected. Does that mean new claimants, or does that mean new tenancies? If an existing claimant has to move from one property to another, does that mean that they then lose out? That clarification would be welcome.
Why is the evidence review into the decision not completed yet? It started in December 2014, I think, and should have been completed last year. It is still not complete. Is there a reason for that delay? When will the review be finished? Will the Minister announce a full exemption from the LHA cap for all tenants in supported housing? Has a cost-benefit analysis of the decision and the delay taken place? The impact of the decision has one cost and the impact of the delay has another.
Has anyone looked not only at demand now, but future demand? For instance, has there been any review of how many women applied for housing because of domestic violence, whether nationally or locally? Does the Minister know what the figure is for his constituency? We need to look at future demand. We are making decisions now when demand is growing.
Yesterday, a written response came back to a parliamentary question. The question was:
“To ask the Secretary of State for Work and Pensions, what estimate he has made of the number of disabled people living in social housing who will be affected by the cap to local housing allowance.”
The response was:
“The information requested is not available. As such it is not possible to accurately estimate the number of disabled people living in social housing that will be affected by this policy”.
How can we have a policy that is costed when we do not know how many people it affects?
The hon. Members for Waveney (Peter Aldous) and for Peterborough said that this is a cross-party and cross-agency issue. It will affect the NHS, the courts and the probation service, so it needs an in-depth look. David Orr, the chief executive of the National Housing Federation, is a man I do not agree with on everything, but he has said:
“This decision must be made and it must be made quickly.”
I agree, and I look forward to the Minister’s answers.
It is a pleasure to serve under your chairmanship, Mr Hollobone, in an important debate, which I have listened to with great interest. The hon. Member for Erith and Thamesmead (Teresa Pearce) outlined the level of interest in this issue, which I have been impressed by not just here today, but in previous debates in the main Chamber, where Members from all parts of the House have spoken. This debate has shown that Members care passionately about this issue. They have shown that here today and have spoken about it in conversations and debates previously. That is a good sign. I welcome the comments in support of some of the excellent work across the sector. We all share an enthusiasm and a commitment to sort out this important part of the housing market and to protect vulnerable people in the wider sense.
I want to outline for hon. Members some of the things that we are looking to do, so that we have the context. In our welfare reforms we are determined to ensure that we deliver a system that rewards hard work, that is fair to taxpayers as well as to claimants, and that always protects the most vulnerable. Yes, the welfare reforms we are introducing are wide-ranging. They need to look at all aspects of welfare spending, including housing benefit costs on supported housing, which are currently estimated to be running at more than £4 billion annually, and we need to be aware of that. Nevertheless, protecting the most vulnerable in society and supporting their housing needs is just as much a priority as driving down the deficit, and there need not be a contradiction between those two aims. In fact, as my hon. Friends the Members for Waveney (Peter Aldous) and for Peterborough (Mr Jackson) rightly pointed out, we should be looking to make a clean start and to get an holistic response.
On that point, with all respect to the Minister, may I point out that in Peterlee in my constituency the shelter for victims of domestic violence will close? That centre is full and over-subscribed. The figures suggest that every week two women are murdered by their partner or former partner. That must be a cause for concern when not only the Peterlee shelter but eight others across the north-east are apparently about to close.
I suggest that if the hon. Gentleman reads what was said when we had a longer debate on this subject in the main Chamber just a couple of months ago, he will see that we were very clear that we will make sure that the most vulnerable are protected. He is presupposing something that nobody has suggested is going to happen.
Look at our track record on supporting the most vulnerable. We have set aside more than £500 million to create a safety net against homelessness. We have increased funding for central programmes to reduce homelessness even further over the next four years. That funding will include a new national programme of millions of pounds to support and scale-up work on rough sleeping. On the specific subject that was just raised, we have pledged £40 million for domestic abuse services, ensuring that no victim is turned away from the support they need. At the autumn statement we announced £400 million to deliver thousands more specialist affordable homes for the vulnerable, the elderly and those with disabilities. The Department of Health has committed to fund up to 7,500 further specialised homes for disabled and older people.
We have spent around £50 billion every year on benefits to support people with disabilities or health conditions, and that spending will be higher than it was in 2010 in every year until 2020. Funding for supported housing is also part of the Government’s wider financial settlement to councils, which includes £5.3 billion in the better care fund, and will result in councils being better able to work together, across agencies, and to invest in early action to help people to live safely in their homes for longer, which, ultimately, is what most people want to be able to do.
We understand how vital it is that those living in supported accommodation and those who provide it receive appropriate protections. I pay tribute to the excellent providers, some of which have been mentioned this afternoon and many of which I have met in my travels around the country. Indeed, I was a trustee of a foyer some years ago. We all know of examples from our constituencies and around the country of excellent providers doing excellent things to make a real difference to the lives of vulnerable people. That is to be applauded. These organisations do vital work that shows the very best ways of supporting and helping vulnerable people.
While looking after the most vulnerable in society, we must also ensure that funding for supported housing is efficient, workable, transparent and sustainable, in order to provide a secure, quality service that delivers for those who need it and makes the best use of the money available. As the right hon. Member for Newcastle upon Tyne East (Mr Brown) outlined, my Department and the Department for Work and Pensions—this issue crosses Departments—have jointly commissioned an evidence review of the supported housing sector. That review will help us to shape the future based on the latest evidence of the current scope and scale of the supported housing sector. It has included extensive consultation with local authorities, supported housing commissioners and all types of supported housing providers, be they charities, housing associations or providers from the commercial sector.
The review will report shortly, and we will continue to work with and listen to the sector as part of developing a long-term, sustainable funding regime. In the past few weeks I have met David Orr and others and spoken to providers, and I will continue to do so because it is important that we develop a long-term, sustainable funding regime. It is really important that we get it right.
May I throw something else into the mix of the consultation? Because of the different statutory framework we have in Scotland for homeless accommodation, there is a greater need for private sector companies to fill supported accommodation roles in Scotland. The cuts directly impinge on such providers being able to fulfil Scotland’s statutory obligations. Will the Minister take that back as part of his consultation and consider making private accommodation specified accommodation, so that those who need to can claim discretionary housing benefit?
I will come back to the hon. Gentleman on that but, as I outlined, the report will be published shortly and we will then respond to it.
I want to put on the record how grateful I am, as are colleagues from across Government, for all the constructive engagement we have had from providers, local authorities, charities and service user groups. We want to continue to work collaboratively with stakeholders as we develop the sustainable future for supported housing that we all want to see. Based on the findings of the evidence review, my Department will be working closely with others across Government, as well as with representatives of service users, supported housing providers and partners, to develop options. The ambition remains to develop a system that is flexible, meets the needs of tenants and stimulates investment in the sector by creating certainty and clarity on future funding.
The sector has welcomed our decision to have the year-long deferral to ensure that the report can complete and we can feed back on it to give that certainty and confidence as we go forward with the final outline. As we made clear when we announced the deferral, the policy review will ensure appropriate protections for vulnerable people. We have done that, as is evidenced in our actions. The latest Homes and Communities Agency figures openly report that there have been 16,813 older people’s and supported housing completions under our affordable housing, and more than 2,000 starts and almost 1,000 completions have already been recorded under phase 1 of the Department of Health-funded care and support specialised housing programme.
We will always protect the most vulnerable in society and provide them with the support they need and a safe home to live in. We must also ensure that that is sustainable and that they have certainty for the future, which is why it is right that we let the report complete and be published. We will then respond to it as efficiently and quickly as we can to ensure certainty and confidence going forward.
Mr Hollobone, you have presided over a very disciplined debate with a clear purpose: to question the effectiveness of the policies the Government are pursuing and alert the Minister to what I hope are the unintended consequences of the policy as we understand it.
I thank my hon. Friends the Members for Easington (Grahame M. Morris), for York Central (Rachael Maskell), for Wirral West (Margaret Greenwood), for Dulwich and West Norwood (Helen Hayes) and for Brent Central (Dawn Butler) for expressing the Labour party’s point of view. I also thank the two Scottish National party Members who have taken part in this short debate, the hon. Members for Linlithgow and East Falkirk (Martyn Day) and for Kilmarnock and Loudoun (Alan Brown), the latter of whom spoke from the Front Bench. We all had essentially the same point to make: what is proposed is cruel, stupid and expensive.
Even the two Conservative Members who spoke, the hon. Members for Peterborough (Mr Jackson) and for Waveney (Peter Aldous), made the point—correctly—that this is a cross-departmental issue and it is wrong to try to tackle it by focusing only on the Department for Work and Pensions and the Department for Communities and Local Government. If things go wrong, the consequences will be far more broadly felt than at just those two Departments, with effects on the budgets of all sorts of other Departments—certainly including the Home Office and the Department of Health on top of the two I just mentioned.
The Minister gave us a partial answer on when the all-important report is expected: “March” and “spring” have now become “shortly”. I welcome that. I think we will be returning to this matter again when the report is in the public domain. There is still a question mark over what is to happen when universal credit is introduced. The Minister was not able to deal with that today, and I accept that he is a Minister at DCLG rather than DWP, but nevertheless it is a vital question, not only for those who rely on the provision but for those who are bidding for the contracts to make the provision. It is very difficult for the latter to bid for a contract without knowing what the funding arrangements will be post 2018.
Finally, I do not recognise the £4 billion figure that the Minister used at the start of his address. Perhaps I misheard him, but it sounded to me as though he said that supported housing costs £4 billion. I think a number of us will want to pursue that further. I thank everyone who participated in the debate, including the Minister. I can confidently say that we will be returning to this matter again.
Question put and agreed to.
That this House has considered the future funding of supported housing.